COVID-19 infection and outcomes in a population-based cohort of 17 203 adults with intellectual disabilities compared with the general population

  1. Angela Henderson
  2. Michael Fleming
  3. Sally-Ann Cooper
  4. Jill P Pell
  5. Craig Melville
  6. Daniel F Mackay
  7. Chris Hatton
  8. Deborah Kinnear

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Abstract

Adults with intellectual disabilities (ID) may be at higher risk of COVID-19 death. We compared COVID-19 infection, severe infection, mortality, case fatality and excess deaths, among adults with, and without, ID.

Methods

Adults with ID in Scotland’s Census, 2011, and a 5% sample of other adults, were linked to COVID-19 test results, hospitalisation data and deaths (24 January 2020–15 August 2020). We report crude rates of COVID-19 infection, severe infection (hospitalisation/death), mortality, case fatality; age-standardised, sex-standardised and deprivation-standardised severe infection and mortality ratios; and annual all-cause mortality for 2020 and 2015–2019.

Findings

Successful linkage of 94.9% provided data on 17 203 adults with, and 188 634 without, ID. Adults with ID had more infection (905/100 000 vs 521/100 000); severe infection (538/100 000 vs 242/100 000); mortality (258/100 000 vs 116/100 000) and case fatality (30% vs 24%). Poorer outcomes remained after standardisation: standardised severe infection ratio 2.61 (95% CI 1.81 to 3.40) and mortality ratio 3.26 (95% CI 2.19 to 4.32). These were higher at ages 55–64: 7.39 (95% CI 3.88 to 10.91) and 19.05 (95% CI 9.07 to 29.02), respectively, and in men, and less deprived neighbourhoods. All-cause mortality was slightly higher in 2020 than 2015–2019 for people with ID: standardised mortality ratio 2.50 (95% CI 2.18 to 2.82) and 2.39 (95% CI 2.28 to 2.51), respectively.

Conclusion

Adults with ID had more COVID-19 infections, and worse outcomes once infected, particularly adults under 65 years. Non-pharmaceutical interventions directed at formal and informal carers are essential to reduce transmission. All adults with ID should be prioritised for vaccination and boosters regardless of age.

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  1. Version published to 10.1136/jech-2021-218192
  2. ScreenIT

    SciScore for 10.1101/2021.02.08.21250525: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIACUC: Ethical approval: The programme of research, under which this research project sits, was approved by Scotland’s Public Benefit and Privacy Panel for Health (reference: 1819-0051), Scotland’s Statistics Public Benefit and Privacy Panel (1819-0051), and the University of Glasgow’s College of Medical, Veterinary, and Life Sciences Ethical Committee (reference: 200180081).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The study also found that intellectual disabilities without Down syndrome predicted time to death.(18) Given the evidence presented from our study, along with the pre-existing literature, serious consideration now should be given to the addition of intellectual disabilities, as well as Down syndrome, to the clinically extremely vulnerable list.(18) Strengths and limitations: The study was large and included the entire country’s adult population with intellectual disabilities, as well as a representative proportion of adults in the general population, thereby reducing bias. Presence of intellectual disabilities was sought on everyone. There was a high, 94%, response rate. Importantly, intellectual disabilities was differentiated from specific learning disabilities (such as dyslexia), and autism. The question on intellectual disabilities was subject to cognitive question testing prior to use, to ensure that it accurately captured the condition, and was acceptable to the population. Record linkage was successful on 94.8% and provided data on a wide range of outcomes. COVID-19 testing data, extracted from the ECOSS system for the period investigated (24th January 2020-15th August 2020), may be an underestimate of true community incidence of COVID-19 infection rates due to limited COVID-19 testing during the first wave of the pandemic, although there is no reason to suspect differences in testing rates between the adults with, and without, intellectual disabilities. Case fatality ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.02.08.21250525v1 on medRxiv