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.
Original language | English |
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Article number | n1592 |
Journal | British Medical Journal |
Volume | 374 |
DOIs | |
Publication status | Published - 15 Jul 2021 |
Bibliographical note
Funding Information: This work was supported by the Medical Research Council(MRC) grant MR/V015737/1. TPP provided technical expertise and infrastructure within their data centre pro bono in the context of a national emergency. EJW was supported by MRC project grant MR/S01442X/1. HIM and MR are funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, a partnership between Public Health England and the London School of Hygiene and Tropical Medicine. HK was supported by funding from the PENDA grant from the Foreign, Commonwealth and Development Office. BG’s work on better use of data in healthcare more broadly is currently funded in part by National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, NIHR Applied Research Collaboration Oxford and Thames Valley, the Mohn-Westlake Foundation, NHS England, and the Health Foundation; all DataLab staff are supported by BG’s grants on this work. The views expressed are those of the authors and not necessarily those of the NIHR, NHS England, Public Health England or the Department of Health and Social Care. Funders had no role in
the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare the following: support from the Medical Research Council, TPP, NIHR Oxford Biomedical Research Centre, NIHR Applied Research Collaboration Oxford and Thames Valley, Mohn-Westlake Foundation, NHS England, NIHR Health Protection Research Unit in Vaccines and
Immunisation, the Foreign, Commonwealth and Development Office, and the Health Foundation for the submitted work. EJW has received payments from AstraZeneca for providing training, unrelated to the submitted work. BG has received research funding from the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley,
the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK (HDRUK), the Health Foundation, and the World Health Organization; he also receives personal income from speaking and writing for lay audiences on the misuse of science. IJD has received unrestricted research grants and holds shares in GlaxoSmithKline (GSK) and holds grants from NIHR. LS reports grants from Wellcome, MRC, NIHR, UK Research and Innovation (UKRI), British Council, GSK,
British Heart Foundation, and Diabetes UK outside this work. AS is employed by the London School of Hygiene and Tropical Medicine (LSHTM) on a fellowship sponsored by GSK. KB holds a Sir Henry Dale fellowship jointly funded by Wellcome and the Royal Society. AYSW holds a fellowship from BHF. RM holds a Sir Henry Wellcome Fellowship funded by the Wellcome Trust. HF holds a UKRI fellowship. RME is funded by HDRUK and the MRC.
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Publisher Copyright: No commercial reuse: See rights and reprints http://www.bmj.com/permissions
Citation: Williamson E J, McDonald H I, Bhaskaran K, Walker A J, Bacon S, Davy S et al. Risks of covid-19 hospital admission and death for people with learning disability: population based cohort study using the OpenSAFELY platform BMJ 2021; 374 :n1592
DOI: 10.1136/bmj.n1592