Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio;
Children's Hospital Association, Lenexa, Kansas.
Pediatrics. 2021 Feb;147(2). doi: 10.1542/peds.2020-009217. Epub 2021 Jan 7.
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.
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.
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.
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.
患有神经损伤（NI）的儿童存在同时患有慢性疾病的风险，这会增加他们的医疗复杂性和发病率。我们评估了患有 NI 的儿童同时患有这些疾病的患病率和发病时间。
这项纵向分析包括 2009 年出生且在 IBM Watson Medicaid MarketScan 数据库中连续参加 Medicaid 的 6229 名儿童，这些儿童在 3 岁前被诊断为 NI。NI 通过现有的诊断代码集来定义，该代码集包含导致严重功能障碍、需要专科医疗护理的神经、遗传和代谢疾病。使用医疗保健研究和质量慢性疾病指标系统评估同时患有慢性疾病的患病率和发病时间。使用平均累积功能来衡量多种疾病的年龄趋势。
最常见的 NI 类型为静止性（56.3%），最常见的 NI 诊断为脑瘫（10.0%）。呼吸（86.5%）和消化（49.4%）器官系统最常受到同时患有慢性疾病的影响。在 2、4 和 6 岁时，平均（95%置信区间[CI]）同时患有慢性疾病的数量分别为 3.7（95% CI 3.7-3.8）、4.6（95% CI 4.5-4.7）和 5.1（95% CI 5.1-5.2）。随着年龄的增长，患有≥9 种同时患有慢性疾病的儿童比例逐渐增加：2 岁时为 5.3%，4 岁时为 10.0%，6 岁时为 12.8%。
参加 Medicaid 的患有 NI 的儿童患有大量早期发生的多种疾病。对患有 NI 的儿童的多种疾病的发病时间和类型的关注度增加，可能有助于优化他们的预防保健和病例管理卫生服务。
