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Age-related trends in cardiometabolic disease among adults with cerebral palsy
Mark D Peterson1,2, Neil Kamdar2,3, Edward A Hurvitz1
1Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
Insights
Adults with cerebral palsy (CP) experience high rates of cardiometabolic diseases, including hypercholesterolemia and hypertension. Disease-free survival significantly decreases with advancing age in this population.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Cerebral palsy (CP) is a complex neurological disorder affecting movement and posture.
- Adults with CP face unique health challenges, including an increased risk of secondary conditions.
- Longitudinal data on cardiometabolic disease trends in adults with CP are limited.
Purpose of the Study:
- To investigate the longitudinal trends of major cardiometabolic diseases in a large cohort of adults with cerebral palsy.
- To stratify these trends by age groups to identify age-related risks.
- To assess the impact of age on disease-free survival for cardiometabolic conditions in adults with CP.
Main Methods:
- Utilized the Optum Clinformatics Data Mart, a nationwide claims database, for de-identified adult beneficiaries with CP.
- Included adults with at least 3 years of continuous enrollment between 2002 and 2009 (n=2659).
- Examined incident diabetes mellitus, hypercholesterolemia, hypertension, cardiac dysrhythmias, and atherosclerosis using Kaplan-Meier curves and Cox regression analysis, stratified by age (18-39, 40-59, 60+ years).
Main Results:
- Cumulative incidence of cardiometabolic diseases ranged from 6.0% (atherosclerosis) to 34.4% (hypercholesterolemia) over 3 years.
- Age was a significant predictor of survival for all cardiometabolic outcomes.
- Hazard ratios for disease incidence increased substantially with age, particularly in older adults (HR 2.20-5.93).
Conclusions:
- Adults with cerebral palsy exhibit high prevalence rates of cardiometabolic diseases.
- Disease-free survival is significantly compromised with increasing age in adults with CP.
- Hypercholesterolemia and hypertension were the most frequently observed cardiometabolic conditions.
Aim:
To examine the longitudinal trends of cardiometabolic diseases in a large sample of adults with cerebral palsy (CP).
Method:
The Optum Clinformatics Data Mart is a de-identified nationwide claims database of beneficiaries from a single private payer. Beneficiaries were included if they had an International Classification of Diseases, Ninth Revision, Clinical Modification code for a diagnosis of CP. Adults with at least 3 years of continuous enrollment on a single plan between 2002 and 2009 were included in the final analyses (n=2659). We examined the longitudinal trends of incident diabetes mellitus, hypercholesterolemia, hypertension, cardiac dysrhythmias, and atherosclerosis, stratified by age categories: 18 to 39 years, 40 to 59 years, and 60 years and over. Kaplan-Meier product-limit survival curves were compared across age categories for each of the cardiometabolic outcomes, and a Cox proportional hazards regression was run to determine adjusted hazard ratios.
Results:
The cumulative incidence of each of the cardiometabolic diseases ranged from 6.0% for atherosclerosis to 34.4% for hypercholesterolemia at 3 years and over. Risk-adjusted Cox proportional hazard models revealed that age was a robust predictor of survival for each outcome, with higher hazard ratio ranges in middle age (hazard ratio 1.41-2.72) and older adults (hazard ratio 2.20-5.93) compared with young adults.
Interpretation:
Adults with CP have high rates of cardiometabolic diseases; and disease-free survival shortens significantly with higher ages.
What This Paper Adds:
Adults with cerebral palsy have high rates of cardiometabolic diseases. Disease-free survival of all cardiometabolic diseases shortens significantly with higher ages. The highest rates were for hypercholesterolemia and hypertension.
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