Daniel G Whitney1, Tao Xu2, Maryam Berri3. 1. Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. Electronic address: dgwhit@umich.edu. 2. Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, USA. 3. Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
Abstract
BACKGROUND: For adults with cerebral palsy (CP), fragility fractures may be a risk factor for pneumonia, a leading cause of death for this population; yet, the timing and complications are unknown. The objectives were to determine the 30-day pneumonia rate post-fracture and its association with mortality and incident cardiovascular events among adults with CP. METHODS: This retrospective cohort study used nationwide administrative claims data from 01/01/2012-12/31/2017 from a random 20% sample of the Medicare fee-for-service and Optum Clinformatics® Data Mart. Cohorts included ≥18 years of age with CP with an incident fragility fracture (CP + Fx) and comparison cohorts: CP without fractures (CPw/oFx) and without CP with an incident fragility fracture (w/oCP + Fx). Incidence rate (IR) of pneumonia 30-days post-fracture and IR ratios were estimated by age group: 18-40, 41-64, and ≥ 65 years. For CP + Fx, Cox regression examined the association between time-varying pneumonia (within 30-days post-fracture) with mortality and incidence of cardiovascular events 0-30-days and 31-365-days post-fracture. RESULTS: There were 3688 CP + Fx (mean [SD] age, 58.2 [14.9]; 56.4% women), 29,429 CPw/oFx (50.3 [15.8]; 45.9% women), and 363,995 w/oCP + Fx (65.9 [18.3]; 65.5% women). The IR of 30-day pneumonia for CP + Fx was similar across age groups (IR per 100 person-months, 8.4-11.0) and 1.77-16.18-fold higher (all P < 0.05) than comparison cohorts. Peri/post-fracture pneumonia was associated with an increased rate of mortality (30-day-adjusted HR [aHR] = 5.89, 95%CI = 3.54-9.81; 31-365-day aHR = 2.89, 95%CI = 2.13-3.92), congestive heart failure 0-30-days (aHR = 3.64, 95%CI = 2.01-6.57) and 31-365-days (time-dependent), myocardial infarction 31-365-days (aHR = 2.03, 95%CI = 1.11-3.71), and cerebrovascular disease 0-30-days (time-dependent), without evidence of effect modification by age, sex, or fracture site. CONCLUSIONS: Adults with CP are particularly vulnerable to 30-day risk of post-fracture pneumonia and its complications across the adult lifespan and not just in the elderly years.
BACKGROUND: For adults with cerebral palsy (CP), fragility fractures may be a risk factor for pneumonia, a leading cause of death for this population; yet, the timing and complications are unknown. The objectives were to determine the 30-day pneumonia rate post-fracture and its association with mortality and incident cardiovascular events among adults with CP. METHODS: This retrospective cohort study used nationwide administrative claims data from 01/01/2012-12/31/2017 from a random 20% sample of the Medicare fee-for-service and Optum Clinformatics® Data Mart. Cohorts included ≥18 years of age with CP with an incident fragility fracture (CP + Fx) and comparison cohorts: CP without fractures (CPw/oFx) and without CP with an incident fragility fracture (w/oCP + Fx). Incidence rate (IR) of pneumonia 30-days post-fracture and IR ratios were estimated by age group: 18-40, 41-64, and ≥ 65 years. For CP + Fx, Cox regression examined the association between time-varying pneumonia (within 30-days post-fracture) with mortality and incidence of cardiovascular events 0-30-days and 31-365-days post-fracture. RESULTS: There were 3688 CP + Fx (mean [SD] age, 58.2 [14.9]; 56.4% women), 29,429 CPw/oFx (50.3 [15.8]; 45.9% women), and 363,995 w/oCP + Fx (65.9 [18.3]; 65.5% women). The IR of 30-day pneumonia for CP + Fx was similar across age groups (IR per 100 person-months, 8.4-11.0) and 1.77-16.18-fold higher (all P < 0.05) than comparison cohorts. Peri/post-fracture pneumonia was associated with an increased rate of mortality (30-day-adjusted HR [aHR] = 5.89, 95%CI = 3.54-9.81; 31-365-day aHR = 2.89, 95%CI = 2.13-3.92), congestive heart failure 0-30-days (aHR = 3.64, 95%CI = 2.01-6.57) and 31-365-days (time-dependent), myocardial infarction 31-365-days (aHR = 2.03, 95%CI = 1.11-3.71), and cerebrovascular disease 0-30-days (time-dependent), without evidence of effect modification by age, sex, or fracture site. CONCLUSIONS: Adults with CP are particularly vulnerable to 30-day risk of post-fracture pneumonia and its complications across the adult lifespan and not just in the elderly years.
Authors: Sameer K Khan; Stephen P Rushton; David W Shields; Kenneth G Corsar; Ramsay Refaie; Andrew C Gray; David J Deehan Journal: Injury Date: 2014-02-26 Impact factor: 2.586
Authors: Elena Birman-Deych; Amy D Waterman; Yan Yan; David S Nilasena; Martha J Radford; Brian F Gage Journal: Med Care Date: 2005-05 Impact factor: 2.983
Authors: Daniel G Whitney; Edward A Hurvitz; Jennifer M Ryan; Maureen J Devlin; Michelle S Caird; Zachary P French; Elie C Ellenberg; Mark D Peterson Journal: Clin Epidemiol Date: 2018-05-01 Impact factor: 4.790
Authors: Daniel G Whitney; Tao Xu; Daniel Whibley; Dayna Ryan; Michelle S Caird; Edward A Hurvitz; Heidi Haapala Journal: J Clin Med Date: 2022-09-22 Impact factor: 4.964