People with learning disabilities 'extremely vulnerable' to the effects of COVID-19
People with learning disabilities with COVID-19 are five times more likely to be admitted to hospital and eight times more likely to die compared with the general population of England, finds a study published by The BMJ today.
Risks were particularly high for those with severe to profound learning disability, Down's syndrome and cerebral palsy.
The researchers say prompt access to COVID-19 testing and healthcare is warranted for this group, and prioritisation for COVID-19 vaccination and other targeted preventive measures should be considered.
Emerging evidence has shown that people with learning disability are at higher risk from COVID-19 related death compared with the general population. But results from existing studies on other COVID-19 outcomes are often complicated by factors such as deprivation and underlying conditions (comorbidities).
A lack of clarity also exists on the increased risk of COVID-19 deaths among people with milder learning disability.
To explore this further, a team of UK researchers set out to describe the risk of COVID-19 related hospital admissions and deaths among children and adults with learning disability in England compared with the general population.
Their results are based on electronic health records for more than 17 million people registered with a general practice in England linked to hospital admission and mortality data.
Data for 14,312,023 adults and 2,627,018 children were analysed across both waves of the COVID-19 pandemic: wave 1 (registered with a general 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).
Among 90,307 adults on the learning disability 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.
After taking account of potentially influential factors, such as age, sex, ethnicity, and geographical location, adults on the learning disability register had a 5-fold higher risk of COVID-19 related hospital admission and an 8-fold higher risk of COVID-19 related death than adults not on the register.
Rates were higher among those with severe to profound learning disability than those with milder learning disability, and among those in residential care.
Similar patterns were seen for children, but the authors stress that absolute risks of COVID-19 hospital admission and death among children were small.
These are observational findings and the authors point to some limitations, such as focusing only on severe COVID-19 outcomes and being unable to identify everyone with a learning disability from medical records alone. Nevertheless, results were similar after further analyses, and are consistent with the existing literature, suggesting that they are robust.
The findings also highlight gaps in learning disability registers, limiting the reach of the vaccination programme, prompting a call for greater efforts to update and maintain accurate registers so that all eligible individuals can benefit.
Besides vaccination, efforts should continue to protect people with learning disability from COVID-19 adverse outcomes, and more research on the excess COVID-19 risks among people with Down's syndrome and cerebral palsy are needed, they conclude.
This study makes an important contribution to the evidence on how the pandemic has affected this vulnerable group, say researchers in a linked editorial.
Ken Courtenay at the Royal College of Psychiatrists and Vivien Cooper at the Challenging Behaviour Foundation, point to "a hidden calamity" taking place among people with learning disabilities, and say "reasonable adjustments should be made to ensure that information about the pandemic and risk of infection are accessible, and that practical support is provided to protect people and manage risks."
What's more, they say worrying attitudes and prejudices about the value of the lives of people with learning disabilities have surfaced during the pandemic, while the COVID-19 vaccination programme also disadvantaged people with learning disabilities, prioritising people according to age rather than severity of comorbid disorders.
"Before the next pandemic, investment in research is essential, to help us understand the risks faced by people with learning disabilities and how best to protect them from the high risks of hospital admission and death from COVID-19," they write. "People with learning disabilities have the same rights as everyone else, including the right to good health and to be safe from harm."
More information: Risks of covid-19 hospital admission and death for people with learning disability: population based cohort study using the OpenSAFELY platformBMJ (2021). DOI: 10.1136/bmj.n1592