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The effect of physical and mental disability on the survival of people with cerebral palsy has been described previously. 1- 7 There is variation in the reported survival experience reported by these studies, and interest in the effect of hearing and visual disabilities.
It is now accepted that children with cerebral palsy may survive well into adulthood. Factors affecting their survival have impacted on the settlements in legal cases, and there is medicolegal interest in a more complete understanding of the factors associated with early death.
We present data on an updated and larger cohort from the Mersey Cerebral Palsy Register, with longer follow up than the previous report. 2 In addition, the effects of sensory disabilities are described.
SUBJECTS AND METHODS
Cerebral palsy register
The definition of cerebral palsy used is "a group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of its development". 8
The cohort comprised all children with cerebral palsy born between 1966 and 1989, to mothers whose area of residence at the time of birth was in the counties of Merseyside and Cheshire. Multiple data sources were used for ascertainment of cases, as described previously. 9, 10 The subjects on the register were flagged at the National Health Service Central Register (NHSCR) of the Office for National Statistics. Notifications of death are provided with copies of death registrations.
Children whose impairment was due to insult pre- or postnatally up to 28 days after birth were classified as early impairment cerebral palsy (EICP). Children who acquired the cerebral impairment as the result of an insult that occurred at least 28 days after birth and up to the age of 5 years were classified as late impairment cerebral palsy (LICP).
Classification of cognitive, motor, and sensory ability
The data used to classify the cognitive, motor, and sensory abilities were all obtained from the hospital and community child health clinical records. Motor ability was assessed in terms of ambulation and manual dexterity, and sensory ability in two modalities, hearing and vision.
Cognitive ability was based on the measurement of the intelligence quotient (IQ) and was classified into four categories, from normal to severe learning disability. A variety of test procedures...