Cause of death trends among adults with and without cerebral palsy in the United States, 2013–2017

Background: Adults with cerebral palsy (CP) in the United States die much earlier than those without CP, a health inequality likely shaped by causes of death. Existing research has not considered demographic differences in mortality patterns. Objectives: To analyze differences in cause of death for adults who did/did not have CP reported on their death certificates and to assess sex and racial-ethnic difference in causes of death among adult decedents with CP. Methods: Data are from the 2013–2017 US Multiple Cause of Death Mortality files (N = 13,332,871; n = 13,897 with CP). Multiple logistic regression models were used to compare differences in causes of death between adults with and without CP and to determine sex and racial-ethnic differences in causes of death among adults with CP. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated. Results: As compared with decedents without CP, those with CP were more likely to die from pneumonitis (aOR 31.14, 95% CI 29.42–32.96), influenza/pneumonia (8.78, 8.30–9.29), respiratory failure (17.24, 15.19–18.69), and choking (20.66, 18.86–22.62) and less likely to die from heart disease (0.61, 0.58–0.65), cancer (0.12, 0.11–0.13), chronic lower respiratory diseases (0.50, 0.44–0.56), and cerebrovascular diseases (0.66, 0.59–0.75). Among adults with CP, female decedents were more likely than males to die from respiratory failure (1.21, 1.03–1.42), and non-Hispanic Black decedents were more likely than non-Hispanic White decedents to die from heart disease (1.24, 1.07–1.45) and cerebrovascular disease (1.77, 1.29–2.49). Conclusions: In 2013–2017, heart disease was the leading cause of death for adults with and without CP. However, for people with compared to those without CP, likelihood of death from likely preventable respiratory causes of death was higher. Non-Hispanic Black adults were more likely than non-Hispanic White adults to die from heart and cerebrovascular diseases. Public health, clinical, and rehabilitation efforts must use a multifaceted approach to address respiratory and circulatory health among people with CP. Database: United States National Vital Statistics System of the Centers for Disease Control and Prevention Multiple Cause of Death Mortality files (National Bureau of Economic Research: https://www.nber.org/research/data/vital-statistics-mortality-data-nber)