Whitney Daniel G, Min Lillian C, Hurvitz Edward A
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA; Department of Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management and Research, VA Medical Center, Ann Arbor, MI, USA.
Disabil Health J. 2025 Jan;18(1):101683. doi: 10.1016/j.dhjo.2024.101683. Epub 2024 Aug 14.
While research has provided key insights into mortality rates and risks for individuals with cerebral palsy (CP), clinically useable mortality risk estimates remain unreported for adults with CP, especially by key patient-level factors.
The objective of this study was to generate clinically useable mortality risk estimates among adults with CP to inform clinical decision making.
This retrospective cohort study, using a fee-for-service Medicare database, identified adults ≥18-years-old with CP from 01/01/2008-12/31/2010 and followed through 12/31/2019 for death. Mortality risk at 1-, 3-, 5-, and 9-year intervals were selected based on common clinical length of time to reasonably benefit from preventive care. Sex-stratified analyses assessed risk estimates by narrow age group (18-25/26-34/35-44/45-54/55-64/65-74/≥75 years old) and multi-morbidity group (Whitney Comorbidity Index score 0-2/3/4-6/≥7).
Of 24,767 adults with CP, n = 12,962 were men (mean [SD] age = 48.3 [15.0] years) and n = 11,805 were women (age = 49.7 [15.8] years). Loss to follow-up was rare. 1-year risk was similar between men and women (3.4 % vs. 3.3 %), but increased slightly more for men than women through 9-years (30.1 % vs. 28.0 %). As expected, the mortality risk increased with older age and higher WCI scores. The probability of death (and survival) is presented per age and multi-morbidity group for men and women with CP.
Mortality risk estimates were reported at clinically relevant intervals by age, sex, and multi-morbidity status. This information can be used to weigh harm-to-benefit ratios of screening and treatment strategies based on mortality expectancy estimates.
虽然研究已对脑瘫（CP）患者的死亡率和风险提供了关键见解，但针对成年CP患者，临床上可用的死亡风险估计值仍未报告，尤其是按关键患者层面因素划分的估计值。
本研究的目的是生成成年CP患者临床上可用的死亡风险估计值，以指导临床决策。
这项回顾性队列研究使用了按服务收费的医疗保险数据库，识别出2008年1月1日至2010年12月31日期间年龄≥18岁的CP成年患者，并随访至2019年12月31日以确定死亡情况。根据从预防性护理中合理获益的常见临床时长，选择1年、3年、5年和9年间隔的死亡风险。按性别分层的分析按狭窄年龄组（18 - 25/26 - 34/35 - 44/45 - 54/55 - 64/65 - 74/≥75岁）和多重疾病组（惠特尼合并症指数评分0 - 2/3/4 - 6/≥7）评估风险估计值。
在24,767例成年CP患者中，n = 12,962例为男性（平均[标准差]年龄 = 48.3 [15.0]岁），n = 11,805例为女性（年龄 = 49.7 [15.8]岁）。失访情况罕见。男性和女性的1年风险相似（3.4%对3.3%），但在9年期间男性的风险增加略高于女性（3 .01%对28 .0%）。正如预期的那样，死亡风险随年龄增长和惠特尼合并症指数评分升高而增加。给出了成年CP男性和女性按年龄和多重疾病组划分的死亡（和生存）概率。
按年龄组、性别和多重疾病状态报告了临床上相关间隔的死亡风险估计值。该信息可用于根据预期死亡率估计值权衡筛查和治疗策略的利弊比。
