Learning Disability, Down's Syndrome, Cerebral Palsy Tied to COVID-19 Mortality

By Lisa Rapaport

August 16, 2021

(Reuters Health) - People with learning disability, Down's syndrome and cerebral palsy have a higher risk of hospitalization and death from COVID-19 than individuals without these conditions, a recent study suggests.

Researchers examined patient-level data for more than 14 million people registered with primary care practices in the U.K. that used the OpenSAFELY platform, matching these electronic records with government data on hospitalizations and deaths. Overall, they had data on 90,307 people (0.63%) age 16 and older with learning disabilities who were registered with primary care as of March 1, 2020 and followed through August 31, 2020.

Among the adults with learning disabilities, 538 (0.6%) had a COVID-19 hospital admission, 222 (0.25%) had a COVID-related death, and 602 (0.7%) died from other causes. Among adults without learning disabilities, 29,781 (0.2%) had a COVID-19 hospital admission, 13,737 (0.1%) had a COVID-related death, and 69,837 (0.5%) died from other causes.

Compared to adults without learning disabilities, individuals with learning disabilities were significantly more likely to be hospitalized with COVID-19 (hazard ratio 5.30) or die from COVID-19 (HR 8.21) in adjusted analysis that accounted for age, sex, ethnicity, and geographical location.

Children under 16 years old with learning disabilities were significantly more likely to be hospitalized with COVID-19 (HR 6.21); there were not enough cases to calculate their risk of COVID-related deaths.

"It is likely to be due to a number of different factors, including the presence of medical conditions which increase risk and difficulties with physical distancing due to frequent contact with carers," said lead author Elizabeth Williamson, a professor of biostatistics and health data science at the London School of Hygiene and Tropical Medicine in the U.K.

"There may also be differences in quality of healthcare and barriers in accessing care," Williamson said by email.

The increased risk of COVID-19 hospitalizations was higher with profound learning disabilities (HR 7.75) than with mild learning disabilities (HR 4.74); the increased risks for COVID-related deaths were similar in those groups.

COVID-19 hospitalization risk was also higher with Down's syndrome (HR 10.59) and cerebral palsy (HR 4.95) than without these conditions, and so was the risk of COVID-related deaths (HR 36.34 and 5.83, respectively).

In addition, the study, published in The BMJ, found that the increased risk of COVID-19 hospitalizations was higher for people with learning disabilities who lived residential care facilities (HR 8.72) that for those who lived in the community (HR 4.87). COVID-related deaths were also more common for those in residential facilities (HR 10.65) than in the community (HR 7.81).

Certain regions of the UK were more heavily represented than others due to geographic variation in the selection of electronic health record systems in primary care practices, the study team notes. As a result, the study outcomes might not be nationally representative.

Still, the results underscore that patients with learning disabilities have increased risk of severe COVID-19 outcomes and that these patients should be priorities for vaccination and other measures to prevent infection, said Dr. Julia Hippisley-Cox of the University of Oxford, a general practitioner with the National Health Service who wasn't involved in the study.

"Clinicians, carers and people with intellectual disabilities should all be aware of the importance of preventative measures such as PPE, isolation and social distancing to minimize transmission," said Angela Henderson, director of impact and policy at the Scottish Learning Disabilities Observatory at the University of Glasgow.

"Ensuring that people with intellectual disabilities of all ages are prioritized for vaccination and subsequent boosters is critical to reducing the increased risk to people with intellectual disabilities," Henderson, who wasn't involved in the study, said by email.

SOURCE: https://bit.ly/37KWl2c The BMJ, online July 15, 2021.

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