Socioeconomic status, environmental factors, and motor function in children with cerebral palsy
Hana F Alazem1, Ewa Sucha2, Richard J Webster2,3
1CHEO Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Insights
Higher socioeconomic deprivation and greater distance to children's treatment centers (CTCs) are linked to increased cerebral palsy (CP) motor impairment. Addressing these factors may reduce social inequalities for children with CP.
Area of Science:
- Pediatrics
- Environmental Health
- Public Health
Background:
- Socioeconomic status (SES) is a known determinant of health outcomes.
- Cerebral palsy (CP) motor function can be influenced by various clinical and environmental factors.
- Understanding the interplay of SES, environmental exposures, and CP severity is crucial for targeted interventions.
Purpose of the Study:
- To examine the association between socioeconomic status and cerebral palsy (CP) motor function.
- To adjust for clinical risk factors, air pollution, and distance to children's treatment centers (CTCs).
- To identify modifiable risk factors contributing to motor impairment in children with CP.
Main Methods:
- A cross-sectional study using data from the CP-NET database in Ontario, Canada.
- Ordinal logistic regression was employed to assess the relationship between deprivation quintiles and Gross Motor Function Classification System (GMFCS) levels.
- Analyses were adjusted for gestational age, birthweight, maternal illness, distance to CTC, nitrogen dioxide, and fine particulate matter.
Main Results:
- A cohort of 292 children aged 2-7 years with CP was analyzed.
- Higher material deprivation was significantly associated with increased CP motor impairment (OR=2.85, p=0.025).
- Increased distance to a CTC was also linked to greater motor impairment (OR=1.70, p=0.003), while air pollution showed no significant association.
Conclusions:
- Socioeconomic deprivation and proximity to healthcare services are associated with CP motor impairment.
- These findings highlight the need to address social inequalities affecting children with CP.
- Further research into modifiable risk factors can inform public health policies and advocacy efforts.
Aim:
To investigate the association between socioeconomic status and cerebral palsy (CP) motor function, adjusting for known clinical and candidate environmental risk factors, that is, air pollution and distance to a children's treatment center (CTC).
Method:
This cross-sectional study examined data from CP-NET, a database of children with CP from Ontario, Canada. To estimate the association of socioeconomic status represented by deprivation quintiles and CP motor function (Gross Motor Function Classification System [GMFCS] level), we fitted an ordinal logistic regression adjusted for gestational age, birthweight for gestational age, maternal illness, distance to a CTC, and the pollution indicators nitrogen dioxide and fine particulate matter with a diameter of 2.5 μm or less.
Results:
The final cohort (n = 292; 126 females, 166 males) were functioning in GMFCS levels I to III (n = 217, 74.3%) and GMFCS levels IV and V (n = 75, 25.7%) and were aged 2 to 7 years. A greater proportion of children classified in GMFCS levels IV or V were found in higher material deprivation quintiles with a dose-response (higher deprivation levels associated with increased motor impairment) (odds ratio = 2.85 [95% confidence interval = 1.25-6.65]; p = 0.025). Distance to a CTC was associated with greater CP motor impairment (odds ratio = 1.70 [95% confidence interval = 1.20-2.51]; p = 0.003), while air pollution showed no association.
Interpretation:
Higher levels of deprivation and distance to a CTC were associated with greater CP motor impairment. Further identification of modifiable risk factors can guide advocacy for reducing social inequalities for individuals with CP.
