Dataset Information

Risk of cerebral palsy among the offspring of immigrants.

ABSTRACT:

Background

Cerebral palsy (CP) has a multifactorial etiology, and placental vascular disease may be one major risk factor. The risk of placental vascular disease may be lower among some immigrant groups. We studied the association between immigrant status and the risk of CP.

Methods

We conducted a population-based retrospective cohort study of all singleton and twin livebirths in Ontario between 2002-2008, and who survived ?28 days after birth. Each child was assessed for CP up to age 4 years, based on either a single inpatient or ?2 outpatient pediatric diagnoses of CP. Relative to non-immigrants (n?=?566,668), the risk of CP was assessed for all immigrants (n?=?177,390), and further evaluated by World region of origin. Cox proportional hazard ratios (aHR) were adjusted for maternal age, income, diabetes mellitus, obesity, tobacco use, Caesarean delivery, year of delivery, physician visits, twin pregnancy, preterm delivery, as well as small- and large-for-gestational age birthweight.

Results

There were 1346 cases of CP, with a lower rate among immigrants (1.45 per 1000) than non-immigrants (1.92 per 1000) (aHR 0.77, 95% confidence interval [CI] 0.67 to 0.88). Mothers from East Asia and the Pacific (aHR 0.54, 95% CI 0.39 to 0.77) and the Caribbean (aHR 0.58, 95% CI 0.37 to 0.93) were at a significantly lower risk of having a child with CP. Whether further adjusting for preeclampsia, gestational hypertension, placental abruption or placental infraction, or upon using a competing risk analysis that further accounted for stillbirth and neonatal death, these results did not change.

Conclusions

Immigration and ethnicity appear to attenuate the risk of CP, and this effect is not fully explained by known risk factors.

SUBMITTER: Ray JG

PROVIDER: S-EPMC4096602 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Publications

Risk of cerebral palsy among the offspring of immigrants.

Ray Joel G JG Redelmeier Donald A DA Urquia Marcelo L ML Guttmann Astrid A McDonald Sarah D SD Vermeulen Marian J MJ

PloS one 20140714 7

<h4>Background</h4>Cerebral palsy (CP) has a multifactorial etiology, and placental vascular disease may be one major risk factor. The risk of placental vascular disease may be lower among some immigrant groups. We studied the association between immigrant status and the risk of CP.<h4>Methods</h4>We conducted a population-based retrospective cohort study of all singleton and twin livebirths in Ontario between 2002-2008, and who survived ≥28 days after birth. Each child was assessed for CP up to ...[more]

PMID: 25019202

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Project description:ImportanceCerebral palsy (CP) is considered a pediatric condition despite most individuals with CP living into adulthood. Thus, there is a lack of evidence in adults with CP, which includes a paucity of research examining mental health in this population.ObjectivesTo determine the risk of depression and anxiety in adults with CP compared with an age-, sex-, and practice-matched reference group of adults without CP, using primary care data.Design, setting, and participantsRetrospective longitudinal cohort study set in UK primary care. Data were analyzed using Cox proportional hazards regression analyses adjusted for chronic conditions and visits to their physician. The study period ran from January 1987 to November 2015. Data of entry into the study ranged from January 1987 to September 2015. Data for 1705 adults 18 years or older with CP and 5115 matched adults without CP were extracted. Cerebral palsy was identified using diagnostic codes, and each person with CP was compared with 3 age-, sex-, and practice-matched controls.ExposuresDiagnosis of CP, with a second analysis accounting for comorbidity of intellectual disability (ID).Main outcomes and measuresTime to diagnosis for depression or anxiety following the date of entry into the study in adults with CP (with and without ID) compared with matched controls.ResultsThe mean (SD) age of the 1705 patients with CP and the 5115 adults without CP was 33.3 (15.5) years, and 798 participants (46.8%) were women. Individuals with CP had an increased adjusted hazard of depression (hazard ratio [HR], 1.28; 95% CI, 1.09-1.51) and anxiety (HR, 1.40; 95% CI, 1.21-1.63) compared with the matched reference group. When we accounted for ID comorbidity, there were 363 adults with CP who also had ID (mean [SD] age, 32.1 [13.2] years; 159 women [47.6%]) and 1342 adults with CP who did not have ID (mean [SD] age, 33.6 [16.1] years; 639 women [43.8%]). Only those individuals with CP and no comorbid ID had a higher risk of incident depression (HR, 1.44; 95% CI, 1.20-1.72) and anxiety (HR, 1.55; 95% CI, 1.28-1.87) than their matched controls.Conclusions and relevanceAdults with CP have an increased risk of depression or anxiety. In particular, these results indicate that this association is driven largely by those individuals with CP with no co-occurring ID. Future work is needed in community-based samples to fully elucidate the causal mechanisms driving these associations.

Dataset Information

Risk of cerebral palsy among the offspring of immigrants.

Background

Methods

Results

Conclusions

Publications

Risk of cerebral palsy among the offspring of immigrants.

Similar Datasets

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