COVID-19 infection and outcomes in a population-based cohort of 17,173 adults with intellectual disabilities compared with the general population

Abstract

Abstract
Objectives To compare COVID-19 infection, severe infection, mortality, case-fatality, and excess deaths, among adults with intellectual disabilities and those without.

Design Record-linkage of all adults recorded with intellectual disabilities in Scotland’s Census, 2011, and a 5% sample of other adults, to COVID-19 test results (Electronic Communication of Surveillance in Scotland), hospitalisations (Scottish Morbidity Record 01), and deaths (National Records of Scotland).

Setting General population; 24th January 2020 - 15th August 2020

Participants Successful linkage of 94.8% provided data on 17,173 adults with, and 195,859 without, intellectual disabilities.

Outcomes Crude rates of COVID-19 infection, severe infection (hospitalisation/death), mortality, and case fatality; age-, sex- and deprivation-standardised severe infection and mortality ratios; annual all-cause mortality for 2020 and 2015-2019.

Results Adults with intellectual disabilities had higher rates of COVID-19 infection (957/100,000 versus 513/100,000); severe infection (549/100,000 versus 237/100,000); mortality (259/100,000 versus 114/100,000); and case-fatality (30% versus 24%). Poorer COVID-19 outcomes remained after standardising for age, sex and deprivation: standardised severe infection ratio 2.59 (95% CI 1.80, 3.39) and mortality ratio 3.20 (95% CI 2.16, 4.25). These were higher among 55-64 year olds: 7.12 (95% CI 3.73, 10.50) and 16.16 (95% CI7.69, 24.63) respectively. Among adults with intellectual disabilities, all-cause mortality was only slightly higher in 2020 than the previous five years: standardised mortality ratios 2.49 (95% CI 2.17, 2.81) and 2.38 (95% CI 2.26, 2.49) respectively.

Conclusions Adults with intellectual disabilities were more likely to be infected with COVID-19, and had worse outcomes once infected, particularly those under 65 years. Non-pharmaceutical interventions directed at formal and informal carers are essential to reduce transmission and all adults with intellectual disabilities should be immediately prioritised for vaccination regardless of age.

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Made available under a CC-BY-NC 4.0 International license (http://creativecommons.org/licenses/by-nc/4.0/).

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DOI

https://doi.org/10.1101/2021.02.08.21250525