Yonsei Med J.  2018 Aug;59(6):781-786. 10.3349/ymj.2018.59.6.781.

Incidence of Cerebral Palsy in Korea and the Effect of Socioeconomic Status: A Population-Based Nationwide Study

• Kim SW
• Jeon HR
• Shin JC
• Youk T
• Kim J

• KMID: 2415537
• DOI: http://doi.org/10.3349/ymj.2018.59.6.781

Abstract

PURPOSE
Cerebral palsy (CP) is a neurodevelopmental disorder that causes serious disability. Prematurity and low birth weight (LBW) are known to be the strongest risk factors of CP. While socioeconomic status (SES) has been found to influence the occurrence of CP, prematurity, and LBW, no studies have investigated this effect in Korea. The aim of this study was to evaluate the incidence of CP, prematurity, and LBW in Korea, as well as the effect of SES thereon.
MATERIALS AND METHODS
Data were obtained from the National Health Information Database from 2007 to 2013; persons with a history of CP, prematurity, and LBW were investigated by year. SES was defined in accordance with income quintiles, birth regions, and coverage classification.
RESULTS
The incidence of CP decreased over the last five years, despite increased rates of prematurity and LBW. CP incidence was significantly lower in affluent groups than in the most deprived group, although this difference disappeared after controlling for confounders. The incidence of CP was significantly higher in medical aid beneficiaries, even after controlling for confounders.
CONCLUSION
CP incidence in Korea has decreased over the last five years, despite an increase in high-risk deliveries. Income level had no effect in CP incidence. These results may aid CP management and prevention policies.

Keyword

Cerebral palsy; premature birth; low birth weight; incidence; socioeconomic factors

MeSH Terms

Cerebral Palsy*
Classification
Humans
Incidence*
Infant, Low Birth Weight
Infant, Newborn
Korea*
Neurodevelopmental Disorders
Parturition
Premature Birth
Risk Factors
Social Class*
Socioeconomic Factors

Figure

• 

  Fig. 1 Incidence of CP, prematurity, and LBW by year. CP, cerebral palsy; LBW, low birth weight.

• 

  Fig. 2 Incidence of cerebral palsy according to income group by year.

Reference

1. Durkin MS, Maenner MJ, Benedict RE, Van Naarden Braun K, Christensen D, Kirby RS, et al. The role of socio-economic status and perinatal factors in racial disparities in the risk of cerebral palsy. Dev Med Child Neurol. 2015; 57:835–843. PMID: 25808915.

2. Moon SJ, Choi Y, Chung CY, Sung KH, Cho BC, Chung MK, et al. Normative values of physical examinations commonly used for cerebral palsy. Yonsei Med J. 2017; 58:1170–1176. PMID: 29047241.

3. Hjern A, Thorngren-Jerneck K. Perinatal complications and socio-economic differences in cerebral palsy in Sweden - a national cohort study. BMC Pediatr. 2008; 8:49. PMID: 18973666.

4. Dolk H, Pattenden S, Bonellie S, Colver A, King A, Kurinczuk JJ, et al. Socio-economic inequalities in cerebral palsy prevalence in the United Kingdom: a register-based study. Paediatr Perinat Epidemiol. 2010; 24:149–155. PMID: 20415771.

5. Dowding VM, Barry C. Cerebral palsy: social class differences in prevalence in relation to birthweight and severity of disability. J Epidemiol Community Health. 1990; 44:191–195. PMID: 2148770.

6. Sundrum R, Logan S, Wallace A, Spencer N. Cerebral palsy and socioeconomic status: a retrospective cohort study. Arch Dis Child. 2005; 90:15–18. PMID: 15613504.

7. Wu YW, Xing G, Fuentes-Afflick E, Danielson B, Smith LH, Gilbert WM. Racial, ethnic, and socioeconomic disparities in the prevalence of cerebral palsy. Pediatrics. 2011; 127:e674–e681. PMID: 21339278.

8. Gissler M, Meriläinen J, Vuori E, Hemminki E. Register based monitoring shows decreasing socioeconomic differences in Finnish perinatal health. J Epidemiol Community Health. 2003; 57:433–439. PMID: 12775790.

9. Spencer N, Bambang S, Logan S, Gill L. Socioeconomic status and birth weight: comparison of an area-based measure with the Registrar General's social class. J Epidemiol Community Health. 1999; 53:495–498. PMID: 10562868.

10. Kim DS, Kim YT, Kim TH. Pregnancy outcome and policy support plan for older pregnant women. Seoul: Korean Women's Development Institute;2011.

11. Kim H. Recent trends in maternal and child health indicators and its policy implication. Health Welfare Policy Forum. 2013; 206:49–59.

12. Christensen DL, Baio J, Van Naarden Braun K, Bilder D, Charles J, Constantino JN, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years--autism and developmental disabilities monitoring network, 11 Sites, United States, 2012. MMWR Surveill Summ. 2016; 65:1–23.

13. Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2013; 55:509–519. PMID: 23346889.

14. Clark SL, Hankins GD. Temporal and demographic trends in cerebral palsy--fact and fiction. Am J Obstet Gynecol. 2003; 188:628–633. PMID: 12634632.

15. Dolk H, Pattenden S, Johnson A. Cerebral palsy, low birthweight and socio-economic deprivation: inequalities in a major cause of childhood disability. Paediatr Perinat Epidemiol. 2001; 15:359–363. PMID: 11703684.

16. Oh Y, Park S. Economic analysis of low fertility. Korean J Economics. 2008; 15:91–102.

17. Health Quality Ontario. In vitro fertilization and multiple pregnancies: an evidence-based analysis. Ont Health Technol Assess Ser. 2006; 6:1–63.

18. Platt MJ, Cans C, Johnson A, Surman G, Topp M, Torrioli MG, et al. Trends in cerebral palsy among infants of very low birthweight (<1500 g) or born prematurely (<32 weeks) in 16 European centres: a database study. Lancet. 2007; 369:43–50. PMID: 17208641.