Noncommunicable disease and multimorbidity in young adults with cerebral palsy

Figures & data

Table 1 Descriptive characteristics and NCD prevalence of young adults with and without CP

	Without CP n=448	With CP n=452	p-value
Descriptive characteristics
Age (years), mean ± SD	23.7±2.8	23.6±3.4	0.74
Male, %	40.0	43.4	0.23
Race/ethnicity, %
Non-Hispanic White	73.7	81.2	0.01
Non-Hispanic Black	7.0	11.6	0.02
Hispanic or Mexican American	4.1	2.7	0.23
Unknown/other race	15.2	4.4	<0.001
BMI category, %
Underweight (BMI<18.5)	0.3	24.3	<0.001
Normal weight (BMI 18.5–24.9)	52.2	41.2	0.03
Overweight (BMI 25–29.9)	31.6	18.1	0.01
Obese (BMI≥30)	15.9	16.4	0.87
Smoking status, %	19.3	7.1	<0.001
Chronic NCD and multimorbidity prevalence, %
Musculoskeletal morbidity	7.5	44.9	<0.001
Osteopenia/osteoporosis	2.3	43.6	<0.001
Osteoarthritis	4.1	5.4	0.37
Rheumatoid arthritis	1.8	0.4	0.05
Cardiometabolic morbidity	8.4	20.6	<0.001
Stroke	0.0	0.0	n/a
Hypertension	3.2	11.8	<0.001
Other heart problems	4.1	5.3	0.38
Coronary artery disease	0.0	0.2	0.32
Diabetes	1.4	2.2	0.33
Myocardial infarction	0.0	2.0	0.01
Hyperlipidemia	1.1	3.0	0.04
Pulmonary morbidity	22.2	27.9	0.04
Asthma	21.4	27.0	0.03
Pulmonary embolism	0.9	1.8	0.25
Emphysema	0.0	1.0	0.05
Multimorbidity	7.2	24.3	<0.001

Abbreviations: BMI, body mass index; CP, cerebral palsy; NCD, noncommunicable disease; n/a, not applicable.

Figure 1 Prevalence of morbidity score for adults with CP vs without CP, as well as for adults with CP with GMFCS levels I–III vs IV–V.

Note: Significant differences between adults with and without CP (*), and between GMFCS levels I–III vs IV–V (^#); p<0.05.
Abbreviations: CP, cerebral palsy; GMFCS, Gross Motor Function Classification System.

Table 2 Descriptive characteristics of young adults with cerebral palsy based on motor impairment assessed using the GMFCS

	GMFCS I–III n=231	GMFCS IV–V n=221	Difference p-value
Descriptive characteristics
Age (years), mean ± SD	23.0±3.2	24.3±3.5	0.01
Male, %	39.4	47.5	0.08
Race/ethnicity, %
Non-Hispanic White	84.4	77.9	0.09
Non-Hispanic Black	9.6	14.0	0.14
Hispanic or Mexican American	1.7	3.6	0.21
Unknown/other race	4.3	4.5	0.56
BMI category, %
Underweight (BMI<18.5)	10.8	38.5	<0.001
Normal weight (BMI 18.5–24.9)	43.7	38.4 0.26
Overweight (BMI 25–29.9)	22.9	13.1	0.01
Obese (BMI≥30)	22.6	10.0	<0.001
Smoking status, %	10.4	3.8	0.01
Distribution, %
Quadriplegia	17.1	93.6	<0.001
Hemiplegia	38.7	1.9	<0.001
Diplegia	44.2	4.5	<0.001
Chronic NCD and multimorbidity prevalence, %
Musculoskeletal morbidity	31.2	59.3	<0.001
Osteopenia/osteoporosis	29.1	58.6	<0.001
Osteoarthritis	3.1	7.7	0.02
Rheumatoid arthritis	0.0	0.9	0.14
Cardiometabolic morbidity	15.2	26.2	<0.01
Stroke	0.0	0.0	n/a
Hypertension	9.1	15.0	0.04
Other heart problems	2.1	8.6	0.01
Coronary artery disease	0.0	0.5	0.31
Diabetes	1.7	2.7	0.47
Myocardial infarction	1.3	2.3	0.43
Hyperlipidemia	2.2	3.2	0.51
Pulmonary morbidity	25.5	30.3	0.26
Asthma	24.8	28.6	0.36
Pulmonary embolism	0.4	3.5	0.02
Emphysema	0.4	0.5	0.96
Multimorbidity	15.2	33.9	<0.001

Abbreviations: BMI, body mass index; GMFCS, Gross Motor Function Classification System; NCD, noncommunicable disease.

Table 3 Multiple logistic regression models for predictors of musculoskeletal, cardiometabolic, and pulmonary morbidities

	Model predictor(s)		Odds ratio	95% CI	p-value
Musculoskeletal morbidity	Cerebral palsy	Unadjusted	10.10	6.77–15.1	<0.001
		Adjusted	6.97	4.46–10.89	<0.001
	Age (years)		1.09	1.03–1.14	<0.001
	Sex (Ref: women)		0.88	0.62–1.26	0.48
	Race (Ref: Non-Hispanic White)		0.86	0.72–1.02	0.08
	BMI category (Ref: normal weight [BMI 18.5–24.9])
	Underweight (BMI<18.5)		1.68	1.03–2.74	0.04
	Overweight (BMI 25–29.9)		0.95	0.59–1.52	0.82
	Obese (BMI≥30)		1.04	0.62–1.73	0.89
	Smoking status (Ref: never smoked)		2.17	1.10–4.25	0.03
Cardiometabolic morbidity	Cerebral palsy	Unadjusted	2.84	1.89–4.26	<0.001
		Adjusted	1.98	1.26–3.13	<0.01
	Age (years)		1.05	0.99–1.11	0.14
	Sex (Ref: women)		1.11	0.75–1.64	0.61
	Race (Ref: Non-Hispanic White)		1.01	0.84–1.20	0.96
	BMI category (Ref: normal weight [BMI 18.5–24.9])
	Underweight (BMI<18.5)		1.30	0.74–2.30	0.37
	Overweight (BMI 25–29.9)		0.65	0.36–1.15	0.13
	Obese (BMI≥30)		1.78	1.06–2.98	0.02
	Smoking status (Ref: never smoked)		1.16	0.61–2.22	0.65
Pulmonary morbidity	Cerebral palsy	Unadjusted	1.36	1.01–1.84	0.04
		Adjusted	1.11	0.78–1.58	0.56
	Age (years)		0.97	0.92–1.02	0.17
	Sex (Ref: women)		1.25	0.90–1.72	0.18
	Race (Ref: Non-Hispanic White)		1.08	0.95–1.2	0.22
	BMI category (Ref: normal weight [BMI 18.5–24.9])
	Underweight (BMI<18.5)		1.15	0.69–1.93	0.58
	Overweight (BMI 25–29.9)		1.06	0.71–1.59	0.78
	Obese (BMI≥30)		1.26	0.79–2.00	0.32
	Smoking status (Ref: never smoked)		1.42	1.02–1.97	0.04

Abbreviations: BMI, body mass index; Ref, reference.

Table 4 Multiple logistic regression models for independent predictors of multimorbidity

	Model predictor(s)		Odds ratio	95% CI	p-value
Multimorbiditya	Cerebral palsy	Unadjusted	4.12	2.71–6.26	<0.001
		Adjusted	2.67	1.69–4.23	<0.001
	Age (years)		1.00	0.94–1.05	0.94
	Sex (Ref: women)		1.14	0.77–1.68	0.51
	Race (Ref: Non-Hispanic White)		0.94	0.78–1.13	0.50
	BMI category (Ref: normal weight [BMI 18.5–24.9])
	Underweight (BMI<18.5)		1.95	1.14–3.33	0.01
	Overweight (BMI 25–29.9)		1.15	0.68–1.94	0.61
	Obese (BMI≥30)		2.04	1.20–3.47	0.01
	Smoking status (Ref: never smoked)		1.92	1.02–3.61	0.04

Note:

a ≥2 musculoskeletal, cardiometabolic, and pulmonary morbidities.

Abbreviations: BMI, body mass index; Ref, reference.