Comorbidity Clusters Among Adults With Cerebral Palsy: A Latent Class Analysis

Reviewed by Kathleen Friel

Citation: Leis AM, Hurvitz EA, Whitney DG. Comorbidity Clusters Among Adults With Cerebral Palsy: A Latent Class Analysis. Am J Prev Med. 2024 Jan 24:S0749-3797(24)00025-4. doi: 10.1016/j.amepre.2024.01.011.

Study type/population: This retrospective cohort study examined comorbidities in over 24,000 adults ≥ 18 years old with cerebral palsy (CP) and the association with mortality up to 11-years of follow-up. Data were collected from adults with CP who had been enrolled in the US Medicare (fee-for-service) claims from January 2008 to December 2010. Data were grouped by age groups: young (age 18-39y), middle (age 40-64y), and older (age >65y).

Key findings: The study examined comorbidity patterns using the Whitney Comorbidity Index, a metric containing 27 comorbidities that most impact adults with CP. Data were analyzed by assigning individuals to different levels of morbidity risk, stratified by age. The proportion of participants in the “Low Morbidity” class declined as people got older. The proportion of participants in the “Complex Multi-Morbidity” class (e.g. cardiorespiratory, nutritional, musculoskeletal, neurological conditions) increased with age. In the “Neurological Multi-Morbidity” class (e.g. epilepsy, intellectual disabilities), the proportion of participants did not significantly change with age, nor did those within the “Complex Multi-Morbidity” class. This is highly relevant, as the conditions in this class - diabetes, bone strength, and osteoarthritis – are typically associated with older adults. Individuals with concurrent "Neurological Multi-Morbidity" and "Complex Multi-Morbidity" had the highest mortality risk.

Translation to Practice: Adults with CP tend to develop comorbidities with age. Importantly, however, the age of onset and constellation of comorbidities differ between adults with CP and typically developed adults. This study identifies comorbidities that develop in people with CP at different ages than in people without CP. Specifically, bone health and blood sugar regulation decline faster in adults with CP than people without CP. Medical providers will benefit from understanding the lifespan timing of these comorbidities in adults with CP, to screen for the appropriate comorbidities at younger ages.