Whitney Daniel G
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA.
Prev Med Rep. 2022 Jul 28;29:101933. doi: 10.1016/j.pmedr.2022.101933. eCollection 2022 Oct.
Epidemiologic evidence documenting risk of chronic diseases as children with cerebral palsy age throughout growth is lacking to inform prevention strategies. The objective was to characterize the 5-year risk of chronic diseases that are typically associated with advanced aging among < 1-13 year olds with cerebral palsy and effects by patient-level factors. This retrospective cohort study used nationwide commercial administrative claims from 01/01/2001-12/31/2018 from children < 1-13 years old with ≥ 5 years of mostly continuous insurance enrollment. The 5-year risk of chronic diseases was examined for the entire cohort with and without cerebral palsy and then by baseline age group (<1-2, 3-5, 6-8, 9-11, 12-13 years old), including cardiorespiratory, metabolic, kidney, and liver diseases, cancer, depression, and osteoarthritis. For cerebral palsy, the association between 5-year chronic disease rate and patient-level factors was assessed using Cox regression. Children with (n = 5,559) vs without (n = 2.3 million) cerebral palsy had a higher 5-year risk of all chronic diseases when comparing the entire cohorts (relative risk, 1.19 to 64.26, all < 0.05) and most chronic diseases when comparing cohorts for each age group. Among children with cerebral palsy, there were effects by gender, co-occurring intellectual disabilities and/or epilepsy, and wheelchair use for some chronic diseases, which can help to identify at-risk children. This study provides novel epidemiologic evidence of 5-year risk of "adult-onset" chronic diseases for children with cerebral palsy during important developmental stages, and associated patient-level factors (to enhance clinical detection). Findings may inform when to implement prevention strategies and who may be more at risk.
缺乏关于脑瘫儿童在整个成长过程中随着年龄增长患慢性病风险的流行病学证据，这不利于制定预防策略。本研究的目的是描述1至13岁脑瘫儿童中通常与衰老相关的慢性病的5年风险，以及患者层面因素的影响。这项回顾性队列研究使用了2001年1月1日至2018年12月31日全国范围内的商业行政索赔数据，这些数据来自1至13岁且至少连续参保5年的儿童。研究考察了整个队列中有无脑瘫儿童的慢性病5年风险，然后按基线年龄组（1至2岁、3至5岁、6至8岁、9至11岁、12至13岁）进行分析，包括心肺疾病、代谢性疾病、肾脏疾病、肝脏疾病、癌症、抑郁症和骨关节炎。对于脑瘫，使用Cox回归评估5年慢性病发病率与患者层面因素之间的关联。与无脑瘫儿童（n = 230万）相比，有脑瘫儿童（n = 5559）在整个队列比较中所有慢性病的5年风险更高（相对风险为1.19至64.26，均P < 0.05），在各年龄组队列比较中大多数慢性病的风险也更高。在脑瘫儿童中，性别、同时存在的智力残疾和/或癫痫以及是否使用轮椅对某些慢性病有影响，这有助于识别高危儿童。本研究提供了新的流行病学证据，表明脑瘫儿童在重要发育阶段患“成人发病型”慢性病的5年风险以及相关的患者层面因素（以加强临床检测）。研究结果可为何时实施预防策略以及哪些人可能风险更高提供参考。
