People with learning disability at greater risk of hospitalization, death due to COVID-19

Individuals with learning disability show much higher risks of being admitted to a hospital and dying from COVID-19 compared with risks seen for non-COVID causes of death, reveals a study.

“Prompt access to COVID-19 testing and healthcare is warranted for this vulnerable group, and prioritization for COVID-19 vaccination and other targeted preventive measures should be considered,” the researchers said.

In this population-based cohort study, the researchers collected patient-level data for more than 17 million people registered with a general practice in England that uses TPP software and linked electronic health records with death data from the Office for National Statistics and hospital admission data from NHS Secondary Uses Service.

Adults (aged 16–105 years) and children (aged <16 years) from two cohorts (wave 1: registered with a TPP practice as of 1 March 2020 and followed until 31 August 2020; wave 2: registered 1 September 2020 and followed until 8 February 2021) participated in this study.

People on a general practice learning disability register comprised the main exposure group. A subgroup was defined as those with profound or severe learning disability. The researchers then identified those with Down syndrome and cerebral palsy whether or not they were on the learning disability register.

A total of 14,312,023 adults were included in wave 1, of which 90,307 (0.63 percent) were on the learning disability register. [BMJ 2021;374:n1592]

Among those on the register, 538 (0.6 percent) had a COVID-19–related hospital admission, while 222 (0.25 percent) died due to COVID-19 and 602 (0.7 percent) due to other causes. Among adults not on the register, 29,781 (0.2 percent) were admitted to the hospital because of COVID-19, while 13,737 (0.1 percent) were COVID-19–related deaths and 69,837 (0.5 percent) non-COVID deaths.

After adjusting for age, sex, ethnicity, and geographical location, adults on the learning disability register were found to have markedly increased risks of COVID-19–related hospital admission (hazard ratio [HR], 5.3, 95 percent confidence interval [CI], 4.9–5.8) and death (HR, 8.2, 95 percent CI, 7.2–9.4).

Estimates were similar for wave 2 participants. There were more robust associations observed among those classified as having severe to profound learning disability and among those in residential care.

Furthermore, Down syndrome and cerebral palsy contributed to increased hazards for hospital admission and death due to COVID-19 for both waves, with the former to a greater extent. HRs for non-COVID deaths showed comparable patterns with weaker associations.

“More research is warranted on the excess COVID-19 risks among people with Down syndrome,” the researchers said. “Cerebral palsy includes people with a broad range of conditions and severity, and a deeper exploration of COVID-19 risk for this group is needed.”

The patterns of relative risk were likewise increased among children, but COVID-19 deaths and hospitalization were rare, indicating low event rates in this group.

Data from the Office for National Statistics also revealed a higher risk of COVID-19 deaths among people with disabilities in general, but this finding has not been explored through clinical databases partly due to the complexity of generating codelists for broad ranges of conditions. [https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/coronaviruscovid19relateddeathsbydisabilitystatusenglandandwales/24januaryto20november2020]

“However, using learning disability register data has highlighted the importance of public health surveillance and the need to develop indicators for disability,” the researchers said.

“We used an indicator of care home residence to explore the extent to which this factor might mediate the association between learning disability and COVID-19, but more detailed and accurate information on care home residence status is needed to understand how best to mitigate risk for people in residential care,” they added.