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Children With Cerebral Palsy: Racial Disparities in Functional Limitations

Maenner, Matthew J.; Benedict, Ruth E.; Arneson, Carrie L.; Yeargin-Allsopp, Marshalyn; Wingate, Martha S.; Kirby, Russell S.; Van Naarden Braun, Kim; Durkin, Maureen S.

doi: 10.1097/EDE.0b013e31823a4205
Child Development

Background: Previous studies of the frequency of cerebral palsy in the United States have found excess prevalence in black children relative to other groups. Whether the severity of cerebral palsy differs between black and white children has not previously been investigated.

Methods: A population-based surveillance system in 4 regions of the United States identified 476 children with cerebral palsy among 142,338 8-year-old children in 2006. Motor function was rated by the Gross Motor Function Classification System and grouped into 3 categories of severity. We used multiple imputation to account for missing information on motor function and calculated the race-specific prevalence of each cerebral palsy severity level.

Results: The prevalence of cerebral palsy was 3.7 per 1000 black children and 3.2 per 1000 white children (prevalence odds ratio [OR]=1.2 [95% confidence interval=1.0–1.4]). When stratified by severity of functional limitation, the racial disparity was present only for severe cerebral palsy (black vs. white prevalence OR=1.7 [1.1–2.4]). The excess prevalence of severe cerebral palsy in black children was evident in term and very preterm birth strata.

Conclusion: Black children in the United States appear to have a higher prevalence of cerebral palsy overall than white children, although the excess prevalence of cerebral palsy in black children is seen only among those with the most severe limitations. Further research is needed to explore reasons for this disparity in functional limitations; potential mechanisms include racial differences in risk factors, access to interventions, and under-identification of mild cerebral palsy in black children.

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From the aWaisman Center, University of Wisconsin-Madison, Madison, WI; bDepartment of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI; cDepartment of Kinesiology, Organizational Therapy Program, University of Wisconsin-Madison, Madison, WI; dDivision of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; eDepartment of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL; fDepartment of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL; and gDepartment of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Submitted 19 February 2011; accepted 9 August 2011; posted 11 November 2011.

Supported by the Centers for Disease Control and Prevention through Cooperative Agreements UR3/DD000677 and UR3/ DD000078 as part of the Autism and Developmental Disabilities Monitoring Network. Additional funding for graduate student support for data analysis was provided by the University of Wisconsin-Madison. M.J.M. was partially supported by a grant from the Autism Science Foundation. The authors reported no other financial interests related to this research.

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Correspondence: Matthew J. Maenner, Waisman Center, 1500 Highland Ave, Rm 529A, Madison, WI 53705. E-mail:

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