Cerebral palsy among children of immigrants in Denmark and the role of socioeconomic status

Abstract

Background: Children of immigrants in Denmark have excess risk for some of the most wellestablished risk factors for cerebral palsy (CP). Objectives: To study differences in risk of CP between children of immigrants and children of Danish-born mothers, and explore whether socioeconomic status drives any potential association. Methods: A register-based cohort study including 1,274,616 children born in Denmark between 1981 and 2007. Of these, 2807 had a validated CP diagnosis in the Danish CP Register. We estimated the risk of CP as odds ratios (OR) using logistic regression and assessed mediation through socioeconomic status using natural effect models. Results: In children of Danish-born mothers, 2.2/1000 had CP overall and the prevalence was similar for children of immigrants. However, children of immigrants had lower risk of unilateral spastic CP than children of Danish native-born mothers; OR ¼ 0.59 (95% CI:0.38 e0.91) for Western and OR ¼ 0.79 (95% CI:0.61e1.03) for Non-Western immigrants. By contrast, the risk of bilateral spastic CP was higher in children of Non-Western immigrants (OR ¼ 1.27 (95% CI:1.05e1.53)), especially from Turkey and Pakistan compared with children of Danish native-born mothers. The mediation analysis revealed an indirect effect (through maternal educational level and household income) with an OR of 1.06 (95% CI:0.99e1.14) for children of Non-Western immigrants. Conclusions: While children of immigrants had lower risk of unilateral spastic CP than children of Danish-born mothers, the risk of bilateral spastic CP was increased in children of Non-Western immigrants. Socioeconomic status did not appear to be a significant contributor to the increased risk of bilateral spastic CP.

Etiological risk factors in children with cerebral palsy

“…In a study conducted in Denmark, it is reported that there is no statistically significant difference between maternal smoking during pregnancy and CP risk factors. [ 25 ] The rate of smoking during pregnancy of the mothers included in the study was 18% and the rate of exposure to cigarette smoke during pregnancy was 41%. In a study conducted in Japan, maternal alcohol use during pregnancy was found to be a risk factor for CP, and severe alcohol consumption was shown to be a cause of many neurodevelopmental abnormalities, including CP.…”

Magnitude and clinical characteristics of cerebral palsy among children in Africa: A systematic review and meta-analysis

“…Recent population-based studies from around the world reported that the prevalence of CP was ranging from 1 to nearly 4 per 1,000 live births [ 4 ]. The prevalence of CP is variably reported across different countries which are 1.89 per 1,000 live births in Norway [ 10 ], and 2.2 per 1,000 live births in Denmark [ 11 ]. Furthermore, a population-based study in Bangladesh reported that 3.4 per 1,000 children [ 12 ].…”

“…Moreover, a population-based study in Uganda revealed that the prevalence of CP was 2.9 per 1,000 children in 2017 [ 19 ]. In line with the global trend, CP places a heavy burden of disease on children, families, and society in both developed and developing countries [ 4 , 11 ]. The previous studies done in different countries showed that several factors were associated with CP.…”

The burden of Europe's immigration crisis on mother‐child healthcare services and opportunities for culturally sensitive family‐centred care

“…Compared to native‐born mothers, immigrants from outside Europe have been reported to present with higher rates of intra‐uterine growth restriction, preterm delivery and congenital malformations. Cerebral palsy is also known to be more prevalent among ethnic minorities 3 . Although these issues are often exacerbated by less than optimal socioeconomic conditions, they are also affected by less than adequate policies, which result in a lack of appropriate family and social support and limitations in accessing local information in the new country.…”