Purpose: Individuals with cerebral palsy (CP) are susceptible to early development of high-burden medical conditions, which may place a considerable strain on health care resources. However, little is known about the prevalence of high-burden medical conditions or health care resource utilization among adults with CP. The purpose of this study was to determine the prevalence of high-burden medical conditions and health care resource utilization and costs among adults with CP, as compared to adults without CP. Patients and methods: Cross-sectional data from the 2016 Optum Clinformatics^®, Data Mart, a de-identified nationwide claims database of beneficiaries from a single private payer in the US. ICD-10-CM diagnosis codes were used to identify all medical conditions among beneficiaries with and without CP who were between 18 and 64 years of age. Medical and outpatient pharmacy claims were used to identify annual all-cause health care resource utilization and health care costs as standardized reimbursement and patient out-of-pocket costs. Results: Adults with CP (n=5,555) had higher prevalence and odds of all medical conditions compared to adults without CP (OR=1.3–5.8; all P<0.05), except cancer (OR=1.1; 95% CI=0.9–1.3). Adults with CP had greater annual mean counts of all health care service types (eg, inpatient, emergency department) compared to adults without CP (all P<0.01). Adults with CP had higher unadjusted standardized reimbursement (mean difference=$16,288; cost ratio [CR]=3.0; 95% CI=2.9–3.1) and patient out-of-pocket (mean difference=$778; CR=1.7; 95% CI=1.6–1.7) costs compared to adults without CP. After adjusting for all prevalent medical conditions, adults with CP still had higher standardized reimbursement (CR=2.5; 95% CI=2.5–2.6) and patient out-of-pocket (CR=1.8; 95% CI=1.7–1.8) costs. Conclusion: Adults with CP have a higher prevalence of high-burden medical conditions, health care resource utilization, and health care costs compared to adults without CP. Study findings suggest the need for earlier screening strategies and preventive medical services to quell the disease and economic burden attributable to adults with CP.

Pain is a leading contributor to the global morbidity and disability burden.¹ Pediatric pain is especially problematic, as it may impede healthful development into and throughout adulthood.² For children with autism spectrum disorders (ASD), pain is a highly understudied area, perhaps owing to the misguided historical impression that children with ASD have lower pain sensitivity.³ However, recent evidence has contradicted this perspective⁴ and indicates that pain may be implicated in pathogenesis of poor health outcomes in children with ASD.⁵ Therefore, this study sought to provide recent national estimates of the prevalence of pain among children and adolescents with ASD.

Aim: To examine how social factors might mitigate the elevated risk of mental health disorders in children with cerebral palsy (CP).Method: This cross‐sectional study included 6‐ to 17‐year‐olds with (n=111; 40.4% 6–11y, 59.6% 12–17y) and without (n=29 909; 50.2% 6–11y, 49.8% 12–17y) CP from the 2016 National Survey of Children's Health. Mental health disorders included depression, anxiety, behavior/conduct problems, and attention‐deficit/hyperactivity disorder. Social factors included participation in activities, bully victimization, and difficulty with friendships.Results: After adjusting for sociodemographic factors and the presence of chronic pain, children with CP had higher odds of anxiety (odds ratio [OR] 4.4; 95% confidence interval [CI] 1.9–8.5), behavior/conduct problems (OR 3.9; 95% CI 1.4–11.3), and multimorbidity (OR 2.8; 95% CI 1.1–7.0), but not depression (OR 1.4; 95% CI 0.6–3.8) or attention‐deficit/hyperactivity disorder (OR 1.7; 95% CI 0.6–4.6), compared to controls. With adjustment for participation in activities, the odds of anxiety, behavior/conduct problems, and multimorbidity remained increased in children with CP. With adjustment for difficulty with friendships, the odds of anxiety, behavior/conduct problems, and multimorbidity were no longer increased in children with CP. With adjustment for bully victimization, the odds of behavior/conduct problems and multimorbidity were attenuated in children with CP; however, the odds of anxiety remained increased.Interpretation: The elevated prevalence of certain mental health disorders in children with CP is partly associated with modifiable social factors.What this paper adds: Difficulty with friendships predicts an elevated prevalence of psychiatric conditions in children with cerebral palsy (CP). Bully victimization predicts an elevated prevalence of behavior/conduct problems in children with CP. Low participation does not predict mental health disorders in this population.