Prevalence of high-burden medical conditions and health care resource utilization and costs among adults with cerebral palsy

Figures & data

Table 1 ICD-10 codes used to identify all diagnoses

Group	ICD-10 codes
Cerebral palsy (CP)
Spastic quadriplegic, diplegic, or hemiplegic CP; athetoid CP; ataxic CP; other or unspecified CP	G80 family
Medical conditions and non-communicable diseases
Pain
Central pain syndrome; other chronic pain; chronic pain syndrome; dorsalgia, including panniculitis affecting regions of the neck and back, radiculopathy, cervicalgia, sciatica, lumbago with sciatica, low back pain, pain in thoracic spine, other or unspecified dorsalgia; pain in joint, including shoulder, elbow, wrist, hand, hip, knee, ankle/foot	G890, G8929, G894, M54 family, M255 family
Fracture
Osteoporosis with current pathological fracture; fracture of skull and facial bones, cervical vertebra and other parts of neck, rib(s), sternum, and thoracic spine, lumbar spine and pelvis, shoulder and upper arm, forearm, wrist and hand, femur, lower leg, including ankle, foot and toe, except ankle	M80 family, S02 family, S12 family, S22 family, S32 family, S42 family, S52 family, S62 family, S72 family, S82 family, S92 family
Ischemic heart disease
Angina pectoris; acute myocardial infarction; subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction; other acute ischemic heart diseases; chronic ischemic heart disease	I20-22 families, I24 family, I25 family
Cerebrovascular disease
Nontraumatic subarachnoid or intracerebral hemorrhage; other and unspecified nontraumatic intracranial hemorrhage; cerebral infarction; occlusion and stenosis of precerebral or cerebral arteries, not resulting in cerebral infarction; other cerebrovascular diseases; cerebrovascular disorders in diseases classified elsewhere; sequelae of cerebrovascular disease	I60-63 families, I65-69 families
Hypertensive and other cardiovascular disease
Essential (primary) hypertension; hypertensive heart, chronic kidney disease, or heart and chronic kidney disease; secondary hypertension; hypertensive crisis; heart failure; peripheral atherosclerosis	I10-13 families, I15 family, I16 family, I50 family, I70 family
Type 2 diabetes mellitus	E11 family
Malignant cancer
Malignant neoplasms of lip, oral cavity, or pharynx, digestive organs, respiratory and intrathoracic organs, bone and articular cartilage, mesothelial and soft tissue, breast, female or male genital organs, urinary tract, eye, brain, or other parts of central nervous system, thyroid or other endocrine glands, ill-defined, other secondary, or unspecified sites, neuroendocrine tumors, lymphoid, hematopoietic, or related tissue; melanoma and other malignant neoplasms of skin	C00-26 families, C30-41 families, C43-58 families, C60-80 families, C7A family, C7B family, C81-96 families
Osteoporosis
With or without current pathological fracture	M80 family, M81 family
Osteoarthritis (OA)
Poly OA; hip OA; knee OA; OA of the first carpometacarpal joint; other and unspecified OA	M15-19 families
Mood affective disorders
Manic episode; bipolar disorder; major depressive disorder, single episode or recurrent; persistent mood (affective) disorders; unspecified mood (affective) disorders	F30-34 families, F39
Anxiety disorders
Phobic anxiety disorders; other anxiety disorders; obsessive-compulsive disorder; reaction to severe stress, and adjust disorders; dissociative and conversion disorders; somatoform disorders; other nonpsychotic mental disorders	F40-45 families, F48 family
Chronic kidney disease
Stage I–V; end stage renal disease; chronic kidney disease, unspecified	N18 family
Liver disease
Alcoholic liver disease; toxic liver disease; hepatic failure, not elsewhere classified; chronic hepatitis, not elsewhere classified; fibrosis and cirrhosis of liver; other inflammatory liver diseases; other diseases of liver; liver disorders in diseases classified elsewhere	K70-76 families, K77

Table 2 Health care resource utilization by service type

Health care service type	Level 1 Description: Level 2 Description
Inpatient services	Facility Inpatient: Acute and Rehab/Skilled Nursing Facility; Professional Services: Inpatient Visits
Outpatient, ambulatory, and other services	Facility Outpatient (OP): OP Facility Diagnostic, Laboratory, Other, Radiology, and Surgery; Professional Services: Allergy Tests and Injections, Anesthesia, Consultations, Diagnostic Testing, Immunizations and Injections, Laboratory, Mental Health, Obstetrics, Pathology, Physical Medicine/Rehab, Professional Other, Preventive Medicine, Radiology, Surgery, Vision, Hearing, and Speech
Emergency department services	Facility Outpatient: Emergency Room; Professional Services: Emergency Room
Office services	Professional Services: Office Visits
Ancillary	Ancillary: Durable Medical Equipment, Drugs Administered, Home Health/Hospice Visits, Services and Supplies, Transportation Services

Figure 1 Adjusted ORs and 95% CIs of medical conditions between adults (18–64) with cerebral palsy (CP) compared to adults without CP (reference). ORs are adjusted for age and sex.

Abbreviations: HTN, hypertension; CVD, cardiovascular disease.

Table 3 Descriptive characteristics and prevalence of medical conditions among adults with and without cerebral palsy (CP)

	CP (n=5,555)	Without CP (n=5,531,366)
Descriptive characteristics
Age, mean (SD)	42.3 (13.9)	43.8 (13.0)
Sex, %
Female	47.9	53.9
Male	52.2	46.2
Ethnicity, %
White	55.2	53.5
Black	12.1	7.4
Hispanic	8.9	9.4
Asian	2.0	4.3
Unknown/missing	21.8	25.4
Education, %
Less than high school	0.5	0.5
High school diploma	32.0	24.0
More than high school	63.3	73.4
Unknown/missing	4.3	2.1
Household annual income, %
<$40 K	23.8	13.1
$40–59.9 K	10.5	10.0
$60–99.9 K	16.7	20.0
≥$100 K	19.6	34.1
Unknown/missing	29.4	22.8
Insurance coverage
Commercial only	41.5	93.1
Medicare Advantage	58.5	6.9
Medical conditions^a	% (95% CI)	%
Pain	38.6 (37.3, 39.9)	30.4
Fracture	6.3 (5.7, 6.9)	2.7
Ischemic heart disease	5.0 (4.4, 5.6)	3.6
Cerebrovascular disease	6.8 (6.1, 7.5)	1.6
Hypertensive/other cardiovascular disease	37.4 (36.1, 38.7)	25.6
Type 2 diabetes	12.4 (11.5, 13.3)	10.1
Malignant cancer	4.0 (3.5, 4.5)	3.9
Osteoporosis	5.5 (4.9, 6.1)	1.3
Osteoarthritis	14.9 (14.0, 15.8)	7.9
Mood affective disorders	23.4 (22.3, 24.5)	11.2
Anxiety disorders	23.7 (22.6, 24.8)	15.3
Chronic kidney disease	4.3 (3.8, 4.8)	1.9
Liver disease	4.1 (3.6, 4.6)	3.0

Note: ^aAll medical conditions were significantly higher among adults with vs without CP (P<0.0001 using chi-squared test), except for malignant cancer (P=0.74).

Table 4 Health care resource utilization in 2016 among adults with and without cerebral palsy (CP)

	CP (n=5,555)		Without CP (n=5,531,366)
	Mean count (SD)	% patients^a	Mean count (SD)	% patients^a	P-value (Mean count)^b	P-value (%)^c
Inpatient visits	3.0 (8.2)	23.7	0.4 (2.5)	7.3	<0.0001	<0.0001
Outpatient and other visits	16.6 (20.9)	97.5	7.4 (10.3)	94.9	<0.0001	<0.0001
Emergency department visits	1.0 (1.9)	38.4	0.3 (0.9)	19.0	<0.0001	<0.0001
Office visits	6.7 (6.4)	93.1	4.0 (4.6)	85.8	<0.0001	<0.0001
Ancillary use	9.4 (27.0)	74.5	1.4 (5.8)	35.5	<0.0001	<0.0001

Notes: ^aPercentage of patients who used the service at least once. ^bGroup differences were tested using generalized linear model with zero-inflated Poisson distribution and log-link function. ^cGroup differences were tested using chi-squared tests.

Figure 2 Mean all-cause total, medical, and pharmacy standardized reimbursement costs (A) and mean all-cause total, medical, and pharmacy patient out-of-pocket costs (B) in 2016 among adults (18–64 years) with and without cerebral palsy (CP).

Table 5 Adjusted cost ratios (CRs) in 2016 among adults with and without cerebral palsy (CP)

	Standardized reimbursement	Patient out-of-pocket
	CR (95% CI)	CR (95% CI)
With CP (ref: without CP)	2.54 (2.46, 2.63)	1.75 (1.70, 1.81)
Age (continuous)	1.00 (1.00, 1.00)	1.00 (1.00, 1.00)
Sex (ref: female)	0.77 (0.77, 0.77)	0.82 (0.82, 0.82)
Insurance coverage (ref: commercial only)	1.38 (1.37, 1.38)	0.72 (0.71, 0.72)
Medical conditions and non-communicable diseases (ref: without)
Pain	1.78 (1.78, 1.79)	1.60 (1.60, 1.61)
Fracture	1.90 (1.89, 1.91)	1.55 (1.54, 1.56)
Ischemic heart disease	2.05 (2.04, 2.06)	1.55 (1.54, 1.56)
Cerebrovascular disease	1.98 (1.96, 2.00)	1.42 (1.41, 1.43)
Hypertensive/other cardiovascular disease	1.47 (1.47, 1.48)	1.29 (1.29, 1.30)
Type 2 diabetes	1.42 (1.41, 1.42)	1.26 (1.26, 1.27)
Malignant cancer	3.62 (3.60, 3.64)	1.84 (1.83, 1.85)
Osteoporosis	1.37 (1.36, 1.38)	1.16 (1.15, 1.17)
Osteoarthritis	1.54 (1.53, 1.54)	1.31 (1.30, 1.31)
Mood affective disorders	1.56 (1.55, 1.57)	1.36 (1.36, 1.37)
Anxiety disorders	1.48 (1.47, 1.48)	1.35 (1.35, 1.35)
Chronic kidney disease	3.23 (3.21, 3.26)	1.49 (1.48, 1.50)
Liver disease	2.34 (2.33, 2.36)	1.57 (1.56, 1.57)

Notes: Generalized linear models with gamma distribution and log-link function were performed to estimate adjusted CRs and 95% CIs, which is the exponentiated form of the parameter estimate. Models were adjusted for all variables in the table.

Table 6 Prevalence of medical conditions and health care resource utilization and costs among adults with and without cerebral palsy (CP) stratified by sex

	Female	Without CP (n=2,978,467)	Male	Without CP (n=2,552,899)
	CP (n=2,658)		CP (n=2,897)
Medical conditions, % (95% CI)
Pain	42.6 (40.7, 44.5)	31.6	34.9 (33.2, 36.6)	29.0
Fracture	6.2 (5.3, 7.1)	2.7	6.4 (5.5, 7.3)	2.7
Ischemic heart disease	4.2 (3.4, 5.0)	2.4	5.8 (4.9, 6.7)	5.1
Cerebrovascular disease	7.0 (6.0, 8.0)	1.5	6.7 (5.8, 7.6)	1.7
Hypertensive/other cardiovascular disease	34.4 (32.6, 36.2)	22.2	40.1 (38.3, 41.9)	29.7
Type 2 diabetes	12.6 (11.3, 13.9)	8.8	12.1 (10.9, 13.3)	11.5
Malignant cancer	4.3 (3.5, 5.1)	4.1	3.7 (3.0, 4.4)	3.7
Osteoporosis	6.7 (5.7, 7.7)	2.2	4.4 (3.7, 5.1)	0.3
Osteoarthritis	16.2 (14.8, 17.6)	8.5	13.8 (12.5, 15.1)	7.2
Mood affective disorders	27.3 (25.6, 29.0)	14.0	19.8 (18.3, 21.3)	8.0
Anxiety disorders	28.4 (26.7, 30.1)	18.5	19.5 (18.1, 20.9)	11.5
Chronic kidney disease	3.8 (3.1, 4.5)	1.5	4.8 (4.0, 5.6)	2.2
Liver disease	4.1 (3.3, 4.9)	2.8	4.0 (3.3, 4.7)	3.1
Health care resource utilization, mean count (SD)
Inpatient visits	2.9 (8.0)	0.4 (2.4)	3.0 (8.4)	0.4 (2.6)
Outpatient and other visits	17.9 (21.3)	8.4 (10.7)	15.5 (20.5)	6.2 (9.7)
Emergency department visits	1.0 (2.0)	0.3 (1.0)	0.9 (1.9)	0.3 (0.8)
Office visits	7.3 (6.7)	4.4 (4.9)	6.2 (6.1)	3.5 (4.3)
Ancillary use	9.2 (27.3)	1.4 (5.7)	9.6 (26.8)	1.3 (5.9)
Total health care costs ($), mean (SD)
Standardized reimbursement	25,844 (53,939)	9,421 (27,485)	26,084 (72,855)	8,179 (30, 822)
Patient out-of-pocket	2,097 (3,016)	1,325 (1,945)	2,011 (2,798)	1,122 (2,010)