title: Variation in cerebral palsy profile by socio-economic status.
abstract: OBJECTIVE
  Socio-economic differences in maternal and child health are well recognized, but the role of individual-level and area-level determinants in cerebral palsy (CP) phenotypes is debated. We set out to examine (1) the association between area-level and individual-level measures of socio-economic deprivation and CP phenotype among children, including subtype, severity, and comorbidities; and (2) the direct effect of area-level deprivation not mediated through individual-level deprivation.
  
  
  METHODS
  Regional data from a provincial CP register were analyzed. The outcome of interest was CP phenotype. The area-level exposure was measured using the Pampalon Deprivation Index. Individual-level socio-economic status (SES) was determined using maternal education. We conducted multiple regression models, stratified by preterm birth, controlling for key covariates, and a mediation analysis of area-level deprivation on the association between individual SES and CP phenotype.
  
  
  RESULTS
  A socio-economic gradient in mobility was seen in our cohort, above and beyond differences in maternal and perinatal factors. The added direct effect of area-level deprivation was seen only in children whose mothers were educated to a higher level, suggesting no additional contribution of area-level deprivation in children of mothers with a lower level of education.
  
  
  CONCLUSIONS
  Contextual socio-economic factors can impact the severity of CP. These findings indicate important areas for potential community-level or area-level public health intervention (i.e. neighborhood reinvestment, preventive measures), and suggest that neighborhood-level research in maternal and perinatal health should continue to be pursued.
authors.affiliation: Department of Neurology & Neurosurgery, McGill University, Montreal, QC, Canada.|Department of Pediatrics, McGill University, Montreal, QC, Canada.
authors.forename: Maryam
authors.initials: M
authors.lastname: Oskoui
authors.affiliation: Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada.
authors.forename: Carmen
authors.initials: C
authors.lastname: Messerlian
authors.affiliation: School of Public Health, University of Montreal, Montreal, QC, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Blair
authors.affiliation: Institut national de santé publique du Québec, Montreal, QC, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gamache
authors.affiliation: Department of Neurology & Neurosurgery, McGill University, Montreal, QC, Canada.|Department of Pediatrics, McGill University, Montreal, QC, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Shevell
mesh_terms: D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007234:Infant, Premature; D008297:Male; D010641:Phenotype; D011610:Psychosocial Deprivation; D011792:Quebec; D012042:Registries; D012111:Residence Characteristics; D012720:Severity of Illness Index; D012923:Social Class; D055815:Young Adult