Early adulthood outcomes among individuals with neurologic impairment and technology assistance

Background and objectives — Individuals with neurologic impairment and technology assistance (NI+TA) have frequent interactions with the health care system, but little is known about their health outcomes following childhood. We aimed to describe acute care use and mortality among individuals with NI+TA in early adulthood.

Methods — This was a population-based retrospective cohort study using health administrative data in individuals with childhood-onset NI+TA (enterostomy tubes, cerebrospinal fluid shunts, tracheostomies). Outcomes were measured from 18 years up to age 26 and included hospitalizations, emergency department (ED) visits, and mortality. Event rates per 100 person-years (100PY) were calculated to describe acute care use. Kaplan-Meier curves were used to describe mortality. Survival between groups was compared using the log-rank test.

Results — Among 859 individuals included (49.1% male), after age 18 years, they had 32.7 hospitalizations/100PY (95% CI 29.2-36.7) (baseline 59.3 hospitalizations/100PY [95% CI 51.8-69.0] for age 16; 50.7 hospitalizations/100PY [95% CI 43.1-59.7] for age 17) and 119.0 ED visits/100PY (95% CI 106.9-132.4) (baseline 125.7 visits/100PY [95% CI 111.9-141.1] for age 16; 121.0 visits/100PY [95% CI 105.0-139.4] for age 17). Approximately 1 in 7 (n = 124; 14.4%) died over the period evaluated. Mortality was higher in progressive vs static NI (P < .01) and multiple technologies vs one (P < .01).

Conclusions — Among individuals with NI+TA, hospitalizations in early adulthood were lower than baseline, while ED visits were similar over time. Mortality was common, especially among those with progressive conditions and those with multiple technologies.