Contribution of socio-economic status on the prevalence of cerebral palsy: A systematic search and review

Abstract

Aim: The association between socio-economic status (SES) and cerebral palsy (CP) remains controversial. Preterm birth, low birthweight, and postnatal injuries are accepted mediating risk factors for CP, but the question remains whether SES confers additional risk. The aim of this study was to analyse existing knowledge on the relationship between SES and the risk of CP. Method: We conducted a systematic search and review of potentially relevant research relating to SES and CP published from 1980 to 2012. Heterogeneity between studies did not allow for data aggregation or meta-analysis; therefore, a narrative review was used to summarize the findings. Results: Twelve studies were included in the systematic review. Of these, eight found low SES to be a risk factor for increased CP prevalence. Three studies detected statistically significant associations even after controlling for birthweight and gestational age as variables. Two of these studies also accounted for additional confounding variables (multiple births and timing of CP acquisition) and continued to detect contributory effects of SES. Linear negative correlations between CP prevalence and SES were shown by three studies. Interpretation: Evidence suggests that the effect of SES on CP prevalence goes beyond that of the mediating factors preterm birth, low birthweight, and postnatal trauma. These associations were seen in area-based and, to a lesser extent, individual measures of SES. A better understanding of mediating factors is imperative in developing targeted public health intervention programmes to reduce the prevalence of CP. What this paper adds: There is evidence that socio-economic status (SES) contributes to CP prevalence beyond the effects of known mediating risk factors.Area-based indicators of SES appear to have a greater effect than individual measures.The heterogeneity of measures of SES prevents more effective aggregation and interpretation of data.