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

ABSTRACT

ObjectivesTo compare COVID-19 infection, severe infection, mortality, case-fatality, and excess deaths, among adults with intellectual disabilities and those without. DesignRecord-linkage of all adults recorded with intellectual disabilities in Scotlands 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). SettingGeneral population; 24th January 2020 - 15th August 2020 ParticipantsSuccessful linkage of 94.8% provided data on 17,173 adults with, and 195,859 without, intellectual disabilities. OutcomesCrude 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. ResultsAdults 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. ConclusionsAdults 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. Summary boxO_ST_ABSWhat is already known on this topicC_ST_ABSO_LICOVID-19 mortality is higher within multi-occupancy residences. C_LIO_LIAdults with intellectual disabilities may be at higher risk of COVID-19 mortality than other adults, but there are gaps in the evidence. C_LIO_LICOVID-19 case-fatality may be no different, or as much as 2.75 times higher in adults with intellectual disabilities compared with other adults. C_LI What this study addsO_LICompared with general population adults, adults with intellectual disabilities were almost twice as likely to become infected with COVID-19, 2.3 times as likely to have severe infection, 2.3 times as likely to have COVID-19 mortality, and had 25% higher COVID-19 case-fatality. C_LIO_LIAfter standardising for age, sex and deprivation, people with intellectual disabilities were 3.2 times more at risk of covid-19 mortality and 2.6 times more at risk of severe infection relative to those with no intellectual disabilities C_LIO_LICompared with general population adults, adults with intellectual disabilities had poorer outcomes among non-elderly age-groups particularly those aged 55-65 years, men, and those living in less-deprived neighbourhoods. C_LIO_LINon-pharmaceutical initiatives are important for carers and care-provider organisations, and adults with intellectual disabilities should be prioritised in the national rollouts of COVID-19 vaccination programmes, regardless of age, sex, or neighbourhood deprivation. C_LI