Abstract
BACKGROUND: Children with neurologic impairment (NI) are at risk for developing co-occurring chronic conditions, increasing their medical complexity and morbidity. We assessed the prevalence and timing of onset for those conditions in children with NI. METHODS: This longitudinal analysis included 6229 children born in 2009 and continuously enrolled in Medicaid through 2015 with a diagnosis of NI by age 3 in the IBM Watson Medicaid MarketScan Database. NI was defined with an existing diagnostic code set encompassing neurologic, genetic, and metabolic conditions that result in substantial functional impairments requiring subspecialty medical care. The prevalence and timing of co-occurring chronic conditions was assessed with the Agency for Healthcare Research and Quality Chronic Condition Indicator system. Mean cumulative function was used to measure age trends in multimorbidity. RESULTS: The most common type of NI was static (56.3%), with cerebral palsy (10.0%) being the most common NI diagnosis. Respiratory (86.5%) and digestive (49.4%) organ systems were most frequently affected by co-occurring chronic conditions. By ages 2, 4, and 6 years, the mean (95% confidence interval [CI]) numbers of co-occurring chronic conditions were 3.7 (95% CI 3.7-3.8), 4.6 (95% CI 4.5-4.7), and 5.1 (95% CI 5.1-5.2). An increasing percentage of children had $9 co-occurring chronic conditions as they aged: 5.3% by 2 years, 10.0% by 4 years, and 12.8% by 6 years. CONCLUSIONS: Children with NI enrolled in Medicaid have substantial multimorbidity that develops early in life. Increased attention to the timing and types of multimorbidity in children with NI may help optimize their preventive care and case management health services.
| Original language | English (US) |
|---|---|
| Article number | e2020009217 |
| Journal | Pediatrics |
| Volume | 147 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 1 2021 |
Funding
FUNDING: Supported by the Agency for Healthcare Research and Quality (award K08HS025138; Dr Thomson), the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (award K23HD091295; Dr Feinstein), the National Heart, Lung, and Blood Institute of the National Institutes of Health (award K12HL137943; Dr Antoon), and the Health Resources and Services Administration of the US Department of Health and Human Services (UA6MC31101; Drs Berry and Hall; Children and Youth with Special Health Care Needs Research Network). This information or content and conclusions are those of the authors and does not necessarily represent the official views of the National Institutes of Health, the Agency for Healthcare Research and Quality, or the Maternal and Child Health Bureau. Funded by the National Institutes of Health (NIH).
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health