Noncommunicable disease and multimorbidity in young adults with cerebral palsy

Whitney, Daniel G.; Hurvitz, Edward A.; Ryan, Jennifer M; Devlin, Maureen J.; Caird, Michelle S.; French, Zachary; Ellenberg, Elie C.; Peterson, Mark D.

doi:10.2147/clep.s159405

Cited by 100 publications

(159 citation statements)

References 42 publications

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“…Therefore, the men with CP >70 years with public insurance may be abnormally healthier than what would be expected for a CP diagnosis at that age. Nevertheless, our prevalence trends are concordant with previous research in southeast Michigan showing that young adults (18 to 30 years) with CP have a musculoskeletal morbidity profile that is 10 times higher than young adults without CP, with the trend of musculoskeletal morbidity becoming even more prevalent with older age …”

Section: Discussionsupporting

confidence: 91%

Osteoporosis Epidemiology Among Adults With Cerebral Palsy: Findings From Private and Public Administrative Claims Data

2019

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Individuals with cerebral palsy (CP) have an increased risk for the early development of osteoporosis; however, little is known about the epidemiology of osteoporosis for adults with CP, which is vital to inform clinical practice for osteoporosis prevention, treatment, and management. The purpose of this cross‐sectional study was to determine sex‐stratified prevalence of osteoporosis among adults with CP, as compared with adults without CP. Data from 2016 were extracted from Optum Clinformatics Data Mart (private insurance administrative claims data) and a random 20% sample from the fee‐for‐service Medicare (public insurance administrative claims data). Diagnostic codes were used to identify CP and osteoporosis diagnoses. Sex‐stratified prevalence of osteoporosis was compared between adults with and without CP for the following age groups: 18 to 30, 31 to 40, 41 to 50, 51 to 60, 61 to 70, and >70 years of age. The overall prevalence of osteoporosis was 4.8% for adults without CP (n = 8.7 million), 8.4% for privately insured adults with CP (n = 7,348), and 14.3% for publicly insured adults with CP (n = 21,907). Women and men with CP had a higher prevalence of osteoporosis compared with women and men without CP for all age groups. Finally, publicly insured women and men with CP had a higher prevalence of osteoporosis compared with privately insured women and men with CP for all age groups, except for the similar prevalence among the 18‐ to 30‐year age group. These findings suggest that osteoporosis is more prevalent among adults with CP compared with adults without CP. Study findings highlight the need for earlier screening and preventive medical services for osteoporosis management among adults with CP. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research

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Section: Discussionsupporting

confidence: 91%

Osteoporosis Epidemiology Among Adults With Cerebral Palsy: Findings From Private and Public Administrative Claims Data

2019

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“…Covariates were selected based on their relevance to adults with CP, fracture, and availability in the administrative claims database . Sociodemographic and socioeconomic variables included age, sex, ethnic group, and education level.…”

Section: Methodsmentioning

confidence: 99%

“…Sociodemographic and socioeconomic variables included age, sex, ethnic group, and education level. We have previously reported that adults with CP had a higher prevalence of cardiometabolic diseases and osteoporosis compared with adults without CP . Cardiometabolic diseases and osteoporosis are associated with skeletal fragility in the non‐CP population, and were therefore included as covariates grouped in the following categories: ischemic heart disease (eg, atherosclerotic heart disease); cerebrovascular disease (eg, cerebral infarction); hypertensive and other cardiovascular disease (eg, hypertension, heart failure); type 2 diabetes; and osteoporosis.…”

Section: Methodsmentioning

confidence: 99%

“…The lack of fracture epidemiology among individuals with CP is concerning. Young adults (18 to 30 years) with CP have an elevated prevalence of musculoskeletal diseases, which is 10 times higher compared with young adults without CP . In particular, the prevalence of osteoporosis in young adults with CP (8%) was recently shown to be similar to the general population of adults ≥50 years of age (10%) .…”

Section: Introductionmentioning

confidence: 99%

“…Young adults (18 to 30 years) with CP have an elevated prevalence of musculoskeletal diseases, which is 10 times higher compared with young adults without CP . In particular, the prevalence of osteoporosis in young adults with CP (8%) was recently shown to be similar to the general population of adults ≥50 years of age (10%) . Moreover, the prevalence of osteoporosis becomes more pronounced throughout the adult lifespan among individuals with CP .…”

Section: Introductionmentioning

confidence: 99%

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Adults with Cerebral Palsy have Higher Prevalence of Fracture Compared with Adults Without Cerebral Palsy Independent of Osteoporosis and Cardiometabolic Diseases

Whitney

Alford

Devlin

et al. 2019

Journal of Bone and Mineral Research

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Individuals with cerebral palsy (CP) have an increased risk of fracture throughout their lifespan based on an underdeveloped musculoskeletal system, excess body fat, diminished mechanical loading, and early development of noncommunicable diseases. However, the epidemiology of fracture among adults with CP is unknown. The purpose of this cross‐sectional study was to determine the prevalence of fracture among a large sample of privately insured adults with CP, as compared with adults without CP. Data were from the Optum Clinformatics Data Mart (Eden Prairie, MN, USA), a deidentified nationwide claims database of beneficiaries from a single private payer. Diagnostic codes were used to identify 18‐ to 64‐year‐old beneficiaries with and without CP and any fracture that consisted of osteoporotic pathological fracture as well as any type of fracture of the head/neck, thoracic, lumbar/pelvic, upper extremity, and lower extremity regions. The prevalence of any fracture was compared between adults with (n = 5,555) and without (n = 5.5 million) CP. Multivariable logistic regression was performed with all‐cause fracture as the outcome and CP group as the primary exposure. Adults with CP had a higher prevalence of all‐cause fracture (6.3% and 2.7%, respectively) and fracture of the head/neck, thoracic, lumbar/pelvic, upper extremity, and lower extremity regions compared with adults without CP (all p < 0.01). After adjusting for sociodemographic and socioeconomic variables, adults with CP had higher odds of all‐cause fracture compared with adults without CP (OR 2.5; 95% CI, 2.2 to 2.7). After further adjusting for cardiometabolic diseases, adults with CP had higher odds of all‐cause fracture compared with adults without CP (OR 2.2; 95% CI, 2.0 to 2.5). After further adjusting for osteoporosis, adults with CP still had higher odds of all‐cause fracture compared with adults without CP (OR 2.0; 95% CI, 1.8 to 2.2). These findings suggest that young and middle‐aged adults with CP have an elevated prevalence of all‐cause fracture compared with adults without CP, which was present even after accounting for cardiometabolic diseases and osteoporosis. © 2019 American Society for Bone and Mineral Research.

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Low‐Trauma Fracture Increases 12‐Month Incidence of Cardiovascular Disease for Adults With Cerebral Palsy

Whitney

Prisby

et al. 2019

Journal Orthopaedic Research

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Individuals with cerebral palsy (CP) have poor skeletal and cardiovascular health. However, no studies have examined if skeletal fragility enhances cardiovascular disease (CVD) risk for this population. The purpose of this study was to determine whether adults with CP have higher 12‐month CVD incidence following a low‐trauma fracture compared with adults without CP. Data, from the Optum Clinformatics® Data Mart, were extracted from adults (18+ years) that sustained a low‐trauma fracture between 01/01/2012 and 12/31/2016. The primary outcome measure was incident CVD within 12 months following a low‐trauma fracture. Cox proportional hazards regression models were used to compare 12‐month incident CVD with adjustment for sociodemographics and chronic disease comorbidities. Mean age (SD) at baseline was 54.7 (18.9) for adults with CP (n = 1,025, 43.3% men) and 60.4 (19.7) for adults without CP (n = 460,504, 33.7% men). During the follow‐up, 121 adults with CP (11.8%, mean age [SD] = 63.9 [16.3]) and 45,330 adults without CP (9.8%, mean age [SD] = 74.5 [11.9]) developed CVD. In the fully adjusted model, adults with CP had higher 12‐month post‐fracture CVD incidence (hazard ratio [HR] = 1.63; 95% confidence interval [CI] = 1.37–1.95). When the outcome was stratified by CVD subtype, adults with CP had higher 12‐month post‐fracture incidence of ischemic heart disease (HR = 1.45; 95% CI = 1.09–1.92), heart failure (HR = 1.68; 95% CI = 1.22–2.31), and cerebrovascular disease (HR = 1.96; 95% CI = 1.54–2.50). Study findings suggest that among adults with CP, low‐trauma fracture may enhance 12‐month CVD incidence compared with adults without CP. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:803‐810, 2020

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Noncommunicable disease and multimorbidity in young adults with cerebral palsy

Cited by 100 publications

References 42 publications

Osteoporosis Epidemiology Among Adults With Cerebral Palsy: Findings From Private and Public Administrative Claims Data

Osteoporosis Epidemiology Among Adults With Cerebral Palsy: Findings From Private and Public Administrative Claims Data

Adults with Cerebral Palsy have Higher Prevalence of Fracture Compared with Adults Without Cerebral Palsy Independent of Osteoporosis and Cardiometabolic Diseases

Low‐Trauma Fracture Increases 12‐Month Incidence of Cardiovascular Disease for Adults With Cerebral Palsy

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