Adults with cerebral palsy (CP) represent an increasing population whose health status and health care needs are poorly understood.¹ Mortality records reveal that death due to ischemic heart disease and cancer is higher among adults with CP²; however, there have been no national surveillance efforts to track disease risk in this population. We examined estimates of chronic conditions in a population-representative sample of adults with CP.

Cerebral palsy (CP) is the umbrella term used for a heterogeneous group of etiologies that occur to a developing fetal or infant brain.¹ People diagnosed as having CP have similar hallmark symptoms including issues with movement, coordination, posture, and balance.^1,2 These motor disturbances can also be comorbid with other issues such as behavioral disturbance, cognitive difficulties, communication difficulties, sensory impairments, epilepsy, and intellectual disability (ID).¹It is estimated that CP affects 2 to 3 in 1000 live births, and approximately 1 in 400 people in the United Kingdom live with CP.^3,4

Aim: To compare mortality rates for cardiovascular disease, cancer, and respiratory disease between adults with cerebral palsy (CP) and the general population.Method: A cohort study was conducted using data from adults with CP in England, identified through a primary care data set (the Clinical Practice Research Datalink), with linked data on death registrations from the Office for National Statistics. Cause of death was categorized according to International Classification of Diseases codes. Standardized mortality ratios (SMRs) were calculated to compare mortality rates between adults with CP and the general population, adjusted for age, sex, and calendar year.Results: Nine hundred and fifty‐eight adults with CP were identified (52.5% males, 47.5% females; median age at start of follow‐up 31y [interquartile range 22–43y]) and followed for a total of 7693 person‐years. One hundred and forty‐two patients (15%) died during follow‐up. Adults with CP had an increased risk of death due to cardiovascular disease (SMR: 3.19, 95% confidence interval [CI] 2.20–4.62) and respiratory disease (SMR: 13.59, 95% CI 9.89–18.67), but not from malignant neoplasms (SMR: 1.42, 95% CI 0.83–2.45).Interpretation: We found that adults with CP in England have increased risk of death due to diseases of the circulatory and respiratory systems, supporting findings from two studies that compared cause‐specific mortality rates between adults with CP in the USA and the general population. Further research is required into primary and secondary prevention of cardiovascular and respiratory disease in people with CP worldwide.What this paper adds: Adults with cerebral palsy (CP) in England have 14‐fold increased risk of mortality due to diseases of the respiratory system. They have a 3‐fold increased risk of mortality due to diseases of the circulatory system. Adults with CP had an increased risk of death due to cerebrovascular disease and ischaemic heart disease. The elevated risk of ischaemic heart disease, however, did not reach statistical significance at the 5% per cent level.

Noncommunicable disease and multimorbidity in young adults with cerebral palsy Daniel G Whitney,1 Edward A Hurvitz,1 Jennifer M Ryan,2,3 Maureen J Devlin,4 Michelle S Caird,5 Zachary P French,1 Elie C Ellenberg,1 Mark D Peterson1 1Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; 2Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; 3Department of Clinical Sciences, Brunel University London, Uxbridge, UK; 4Department of Anthropology, University of Michigan, Ann Arbor, MI, USA; 5Department of Orthopedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA Purpose: Individuals with cerebral palsy (CP) are at increased risk for frailty and chronic disease due to factors experienced throughout the lifespan, such as excessive sedentary behaviors and malnutrition. However, little is known about noncommunicable diseases (NCDs) and multimorbidity profiles in young adults with CP. The study objective was to compare NCD and multimorbidity profiles between young adults with and without CP.Methods: A clinic-based sample of adults (18–30 years) with (n=452) and without (n=448) CP was examined at the University of Michigan Medical Center. The prevalence and predictors of 13 NCDs were evaluated, including existing diagnoses or historical record of musculoskeletal, cardiometabolic, and pulmonary morbidities. The level of motor impairment was determined by the Gross Motor Function Classification System (GMFCS) and stratified by less vs more severe motor impairment (GMFCS I–III vs IV–V). Logistic regression was used to determine the odds of NCD morbidity and multimorbidity in adults with CP compared to adults without CP, and for GMFCS IV–V compared to GMFCS I–III in those with CP, after adjusting for age, sex, body mass index, and smoking.Results: Adults with CP had a higher prevalence of osteopenia, osteoporosis, hypertension, myocardial infarction, hyperlipidemia, asthma, and multimorbidity compared to adults without CP, and higher odds of musculoskeletal (odds ratio [OR]: 6.97) and cardiometabolic morbidity (OR: 1.98), and multimorbidity (OR: 2.67). Adults with CP with GMFCS levels IV–V had a higher prevalence of osteopenia/osteoporosis, osteoarthritis, hypertension, other cardiovascular conditions, pulmonary embolism, and multimorbidity, and higher odds of musculoskeletal (OR: 3.41), cardiometabolic (OR: 2.05), pulmonary morbidity (OR: 1.42), and multimorbidity (OR: 3.45) compared to GMFCS I–III.Conclusion: Young adults with CP have a higher prevalence of chronic NCDs and multimorbidity compared to young adults without CP, which is pronounced in those with more severe motor impairment. These findings reiterate the importance of early screening for prevention of NCDs in CP. Keywords: cerebral palsy, noncommunicable disease, multimorbidity, osteoporosis, osteoarthritis, cardiovascular disease, diabetes, pulmonary disease

Aim: To examine the risk, burden, and management of non‐communicable diseases (NCDs) among people with cerebral palsy (CP).Method: Databases (Ovid MEDLINE, Embase Ovid, CINAHL Plus) were systematically searched up to August 2017. Data on the prevalence of risk factors for, and the burden and management of, cardiovascular diseases, diabetes, cancers, and respiratory diseases were extracted.Results: Thirty‐six studies that examined the prevalence of risk factors among people with CP were identified. There was inconsistent evidence that people with CP had higher prevalence of metabolic risk factors such as hypertension, hyperlipidaemia, and obesity, but strong evidence that they participated in low levels of physical activity, compared with people without CP. Seven studies reported on the burden of NCDs. Adults with CP had a higher risk of NCDs, including stroke, chronic obstructive pulmonary disease, and other heart conditions, and death due to NCDs, including cancers, chronic obstructive pulmonary disease, stroke, and ischaemic heart disease, compared with the general population. Only one study reported on the management of NCD, specifically the uptake of breast cancer screening among females.Interpretation: The burden of NCDs is higher among adults with CP compared with the general population. Further research is required to determine the prevalence of metabolic risk factors and management of NCDs among people with CP.What this paper adds: Adults with cerebral palsy (CP) have an increased risk of non‐communicable diseases (NCDs) and increased risk of death because of NCDs. Evidence is inconsistent about the elevated prevalence of metabolic risk factors for NCDs. Evidence is consistent that people with CP participate in reduced physical activity. Only one study reported on management of NCD among people with CP. Available evidence suggests people with CP are less likely to receive preventive medicine.