Variation in cerebral palsy profile by socio-economic status

Dev Med Child Neurol. 2016 Feb;58(2):160-6. doi: 10.1111/dmcn.12808. Epub 2015 May 22.


Aim: Socio-economic differences in maternal and child health are well recognized, but the role of individual-level and area-level determinants in cerebral palsy (CP) phenotypes is debated. We set out to examine (1) the association between area-level and individual-level measures of socio-economic deprivation and CP phenotype among children, including subtype, severity, and comorbidities; and (2) the direct effect of area-level deprivation not mediated through individual-level deprivation.

Method: Regional data from a provincial CP register were analyzed. The outcome of interest was CP phenotype. The area-level exposure was measured using the Pampalon Deprivation Index. Individual-level socio-economic status (SES) was determined using maternal education. We conducted multiple regression models, stratified by preterm birth, controlling for key covariates, and a mediation analysis of area-level deprivation on the association between individual SES and CP phenotype.

Results: A socio-economic gradient in mobility was seen in our cohort, above and beyond differences in maternal and perinatal factors. The added direct effect of area-level deprivation was seen only in children whose mothers were educated to a higher level, suggesting no additional contribution of area-level deprivation in children of mothers with a lower level of education.

Interpretation: Contextual socio-economic factors can impact the severity of CP. These findings indicate important areas for potential community-level or area-level public health intervention (i.e. neighborhood reinvestment, preventive measures), and suggest that neighborhood-level research in maternal and perinatal health should continue to be pursued.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cerebral Palsy*
  • Female
  • Humans
  • Infant, Low Birth Weight
  • Infant, Premature
  • Male
  • Phenotype
  • Psychosocial Deprivation*
  • Quebec
  • Registries*
  • Residence Characteristics*
  • Severity of Illness Index*
  • Social Class*
  • Young Adult