Timing of Co-occurring Chronic Conditions in Children With Neurologic Impairment

Abstract

Background: Children with neurologic impairment (NI) are at risk for developing co-occurring chronic conditions, increasing their medical complexity and morbidity. We assessed the prevalence and timing of onset for those conditions in children with NI.

Methods: This longitudinal analysis included 6229 children born in 2009 and continuously enrolled in Medicaid through 2015 with a diagnosis of NI by age 3 in the IBM Watson Medicaid MarketScan Database. NI was defined with an existing diagnostic code set encompassing neurologic, genetic, and metabolic conditions that result in substantial functional impairments requiring subspecialty medical care. The prevalence and timing of co-occurring chronic conditions was assessed with the Agency for Healthcare Research and Quality Chronic Condition Indicator system. Mean cumulative function was used to measure age trends in multimorbidity.

Results: The most common type of NI was static (56.3%), with cerebral palsy (10.0%) being the most common NI diagnosis. Respiratory (86.5%) and digestive (49.4%) organ systems were most frequently affected by co-occurring chronic conditions. By ages 2, 4, and 6 years, the mean (95% confidence interval [CI]) numbers of co-occurring chronic conditions were 3.7 (95% CI 3.7-3.8), 4.6 (95% CI 4.5-4.7), and 5.1 (95% CI 5.1-5.2). An increasing percentage of children had ≥9 co-occurring chronic conditions as they aged: 5.3% by 2 years, 10.0% by 4 years, and 12.8% by 6 years.

Conclusions: Children with NI enrolled in Medicaid have substantial multimorbidity that develops early in life. Increased attention to the timing and types of multimorbidity in children with NI may help optimize their preventive care and case management health services.

FIGURE 1

Prevalence of co-occurring chronic conditions in children with NI by age 6 years. The percentages shown are of the total cohort of children with NI (n = 6229).

FIGURE 2

Timing of first diagnosis of medical co-occurring chronic conditions present by age 6 years in children with NI. The percentages shown for “% of cohort” are of the total cohort of children with NI (n = 6229). Condition onset marks the first age when the diagnosis was made in a health care claim.

FIGURE 3

Trends in the number of co-occurring chronic conditions through age 6 years for children with NI. Presented on each stacked bar are the percentages of children with NI who, at the particular age in months, had 0, 1, 2 to 4, 5 to 8, and 9+ organ systems affected by their co-occurring chronic conditions. The number of such organ systems increases from bottom (ie, 0 systems) to top (9+ systems) on each bar. An example of findings is that the percentage of children with NI with 0 co-occurring conditions decreased from 50% at age 0 months to 4% at age 24 months and then to <1% by 72 months.

FIGURE 4

Trends in the number of co-occurring chronic conditions through age 6 years for children with NI. The figure is a depiction of the MCF of the number of co-occurring conditions for the entire study population and NI subtypes by age in months. Peripheral and progressive subtypes are not included given the small sample sizes.