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Risks of covid-19 hospital admission and death for people with learning disability: population based cohort study using the OpenSAFELY platform.
Williamson, Elizabeth J; McDonald, Helen I; Bhaskaran, Krishnan; Walker, Alex J; Bacon, Sebastian; Davy, Simon; Schultze, Anna; Tomlinson, Laurie; Bates, Chris; Ramsay, Mary; Curtis, Helen J; Forbes, Harriet; Wing, Kevin; Minassian, Caroline; Tazare, John; Morton, Caroline E; Nightingale, Emily; Mehrkar, Amir; Evans, Dave; Inglesby, Peter; MacKenna, Brian; Cockburn, Jonathan; Rentsch, Christopher T; Mathur, Rohini; Wong, Angel Y S; Eggo, Rosalind M; Hulme, William; Croker, Richard; Parry, John; Hester, Frank; Harper, Sam; Douglas, Ian J; Evans, Stephen J W; Smeeth, Liam; Goldacre, Ben; Kuper, Hannah.
  • Williamson EJ; London School of Hygiene and Tropical Medicine, London, UK.
  • McDonald HI; London School of Hygiene and Tropical Medicine, London, UK.
  • Bhaskaran K; National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London, UK.
  • Walker AJ; London School of Hygiene and Tropical Medicine, London, UK.
  • Bacon S; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Davy S; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Schultze A; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Tomlinson L; London School of Hygiene and Tropical Medicine, London, UK.
  • Bates C; London School of Hygiene and Tropical Medicine, London, UK.
  • Ramsay M; TPP, TPP House, Horsforth, Leeds, UK.
  • Curtis HJ; National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London, UK.
  • Forbes H; Public Health England, London, UK.
  • Wing K; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Minassian C; University of Bristol, Bristol, UK.
  • Tazare J; London School of Hygiene and Tropical Medicine, London, UK.
  • Morton CE; London School of Hygiene and Tropical Medicine, London, UK.
  • Nightingale E; London School of Hygiene and Tropical Medicine, London, UK.
  • Mehrkar A; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Evans D; London School of Hygiene and Tropical Medicine, London, UK.
  • Inglesby P; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • MacKenna B; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Cockburn J; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Rentsch CT; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Mathur R; TPP, TPP House, Horsforth, Leeds, UK.
  • Wong AYS; London School of Hygiene and Tropical Medicine, London, UK.
  • Eggo RM; London School of Hygiene and Tropical Medicine, London, UK.
  • Hulme W; London School of Hygiene and Tropical Medicine, London, UK.
  • Croker R; London School of Hygiene and Tropical Medicine, London, UK.
  • Parry J; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Hester F; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Harper S; TPP, TPP House, Horsforth, Leeds, UK.
  • Douglas IJ; TPP, TPP House, Horsforth, Leeds, UK.
  • Evans SJW; TPP, TPP House, Horsforth, Leeds, UK.
  • Smeeth L; London School of Hygiene and Tropical Medicine, London, UK.
  • Goldacre B; London School of Hygiene and Tropical Medicine, London, UK.
  • Kuper H; London School of Hygiene and Tropical Medicine, London, UK.
BMJ ; 374: n1592, 2021 07 14.
Article in English | MEDLINE | ID: covidwho-1311065
ABSTRACT

OBJECTIVE:

To assess the association between learning disability and risk of hospital admission and death from covid-19 in England among adults and children.

DESIGN:

Population based cohort study on behalf of NHS England using the OpenSAFELY platform.

SETTING:

Patient level data were obtained for more than 17 million people registered with a general practice in England that uses TPP software. Electronic health records were linked with death data from the Office for National Statistics and hospital admission data from NHS Secondary Uses Service.

PARTICIPANTS:

Adults (aged 16-105 years) and children (<16 years) from two cohorts wave 1 (registered with a TPP practice as of 1 March 2020 and followed until 31 August 2020); and wave 2 (registered 1 September 2020 and followed until 8 February 2021). The main exposure group consisted of people on a general practice learning disability register; a subgroup was defined as those having profound or severe learning disability. People with Down's syndrome and cerebral palsy were identified (whether or not they were on the learning disability register). MAIN OUTCOME

MEASURE:

Covid-19 related hospital admission and covid-19 related death. Non-covid-19 deaths were also explored.

RESULTS:

For wave 1, 14 312 023 adults aged ≥16 years were included, and 90 307 (0.63%) were on the learning disability register. Among adults on the register, 538 (0.6%) had a covid-19 related hospital admission; there were 222 (0.25%) covid-19 related deaths and 602 (0.7%) non-covid deaths. Among adults not on the register, 29 781 (0.2%) had a covid-19 related hospital admission; there were 13 737 (0.1%) covid-19 related deaths and 69 837 (0.5%) non-covid deaths. Wave 1 hazard ratios for adults on the learning disability register (adjusted for age, sex, ethnicity, and geographical location) were 5.3 (95% confidence interval 4.9 to 5.8) for covid-19 related hospital admission and 8.2 (7.2 to 9.4) for covid-19 related death. Wave 2 produced similar estimates. Associations were stronger among those classified as having severe to profound learning disability, and among those in residential care. For both waves, Down's syndrome and cerebral palsy were associated with increased hazards for both events; Down's syndrome to a greater extent. Hazard ratios for non-covid deaths followed similar patterns with weaker associations. Similar patterns of increased relative risk were seen for children, but covid-19 related deaths and hospital admissions were rare, reflecting low event rates among children.

CONCLUSIONS:

People with learning disability have markedly increased risks of hospital admission and death from covid-19, over and above the risks observed for non-covid causes of death. Prompt access to covid-19 testing and healthcare is warranted for this vulnerable group, and prioritisation for covid-19 vaccination and other targeted preventive measures should be considered.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hospitalization / Learning Disabilities Type of study: Cohort study / Observational study / Prognostic study Topics: Vaccines Limits: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: Europa Language: English Journal: BMJ Journal subject: Medicine Year: 2021 Document Type: Article Affiliation country: Bmj.n1592

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hospitalization / Learning Disabilities Type of study: Cohort study / Observational study / Prognostic study Topics: Vaccines Limits: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: Europa Language: English Journal: BMJ Journal subject: Medicine Year: 2021 Document Type: Article Affiliation country: Bmj.n1592