ObjectivesTo assess the association between learning disability and risk of hospitalisation and mortality from COVID-19 MESHD
in England among adults and children.
DesignWorking on behalf of NHS England MESHD
, two cohort studies using patient-level data for >17 million people from primary care electronic health records were linked with death data from the Office for National Statistics and hospitalization data from NHS Secondary Uses Service using the OpenSAFELY platform.
SettingGeneral practices in England which use TPP software.
ParticipantsParticipants were males and females, aged up to 105 years, from two cohorts: (1) wave 1 HGNC
, registered with a TPP practice as of 1st March 2020 and followed until 31st August, 2020; (2) wave 2 HGNC
registered 1st September 2020 and followed until 31st December 2020 (for admissions) or 8th February 2021 (for deaths). The main exposure group was people included on a general practice learning disability register (LDR), with a subgroup of people classified as having profound or severe learning disability MESHD
. We also identified patients with Down syndrome and cerebral palsy MESHD
(whether or not on the learning disability register).
Main outcome measures(i) COVID-19 MESHD
related death, (ii) COVID-19 MESHD
related hospitalisation. Non- COVID-19 MESHD
related death MESHD
was also explored.
ResultsIn wave 1 HGNC
, of 14,301,415 included individuals aged 16 and over, 90,095 (0.63%) were identified as being on the LDR. 30,173 COVID-related hospital admissions, 13,919 COVID-19 MESHD
related deaths and 69,803 non-COVID deaths MESHD
occurred; of which 538 (1.8%), 221 (1.6%) and 596 (0.85%) were among individuals on the LDR, respectively. In wave 2 HGNC
, 27,611 COVID-related hospital admissions, 17,933 COVID-19 MESHD
related deaths and 54,171 non-COVID deaths MESHD
occurred; of which 383 (1.4%), 260 (1.4%) and 470 (0.87%) were among individuals on the LDR. Wave 1 HGNC
hazard ratios for individuals on the LDR, adjusted for age, sex, ethnicity and geographical location, were 5.3 (95% confidence interval (CI) 4.9, 5.8) for COVID-19 MESHD
related hospital admissions and 8.2 (95% CI: 7.1, 9.4) for COVID-19 MESHD
related death. Wave 2 HGNC
produced similar estimates. Associations were stronger among those classed as severe-profound and among those in residential care. Down syndrome and cerebral palsy MESHD
were associated with increased hazard of both events in both waves; Down syndrome to a much greater extent. Hazards of non- COVID-19 MESHD
related death followed similar patterns with weaker associations.
ConclusionsPeople with learning disabilities MESHD
have markedly increased risks of hospitalisation and mortality from COVID-19 MESHD
. This raised risk is over and above that seen for non-COVID causes of death MESHD
. Ensuring prompt access to Covid-19 MESHD
testing and health care and consideration of prioritisation for COVID-19 MESHD
vaccination and other targeted preventive measures are warranted.