Associations between deprivation and postneonatal cerebral palsy over 35 years: a population-based longitudinal study

Cerebral palsy (CP) is a non-progressive condition involving movement and muscle tone difficulties due to injury to the developing brain. Most cases arise around birth, but a smaller proportion (postneonatal CP) experience brain injuries between 29 days and 2 years of age. Causes of postneonatal CP are often modifiable and may be more prevalent in socio-economically deprived areas, yet few studies have investigated this issue. We addressed this gap using a population-wide CP register in Northern Ireland.

We conducted a retrospective study linking births between 1981 and 2016 to area-level deprivation data. Bayesian regression models assessed associations between deprivation, postneonatal CP and related outcomes.

Postneonatal CP declined steadily across the study period (IRR=0.89; 89% uncertainty interval (UI) 0.85 to 0.93), especially among individuals from the most deprived backgrounds. While the odds of infection-related postneonatal CP decreased overall, these did not decrease among CP individuals from deprived backgrounds, who also displayed higher odds of postneonatal CP due to head injuries (OR=2.72, 89% UI 1.09 to 5.30). Postneonatal CP was associated with higher odds of severe motor impairment (OR=1.47, 89% UI 1.07 to 2.00), intellectual delay (OR=2.54, 89% UI 1.83 to 3.55) and seizures (OR=2.55, 89% UI 1.84 to 3.56).

Although prevalence has declined, socioeconomic inequalities remain in the causes and consequences of postneonatal CP. These findings highlight the need for targeted public health interventions and further research to address persistent disparities and prevent modifiable causes of CP.