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. 2021 Jul 14:374:n1592.
doi: 10.1136/bmj.n1592.

Risks of covid-19 hospital admission and death for people with learning disability: population based cohort study using the OpenSAFELY platform

Elizabeth J Williamson  1 , Helen I McDonald  1   2 , Krishnan Bhaskaran  1 , Alex J Walker  3 , Sebastian Bacon  3 , Simon Davy  3 , Anna Schultze  1 , Laurie Tomlinson  1 , Chris Bates  4 , Mary Ramsay  2   5 , Helen J Curtis  3 , Harriet Forbes  6 , Kevin Wing  1 , Caroline Minassian  1 , John Tazare  1 , Caroline E Morton  3 , Emily Nightingale  1 , Amir Mehrkar  3 , Dave Evans  3 , Peter Inglesby  3 , Brian MacKenna  3 , Jonathan Cockburn  4 , Christopher T Rentsch  1 , Rohini Mathur  1 , Angel Y S Wong  1 , Rosalind M Eggo  1 , William Hulme  3 , Richard Croker  3 , John Parry  4 , Frank Hester  4 , Sam Harper  4 , Ian J Douglas  1 , Stephen J W Evans  1 , Liam Smeeth  1 , Ben Goldacre  2 , Hannah Kuper  1
Affiliations

Risks of covid-19 hospital admission and death for people with learning disability: population based cohort study using the OpenSAFELY platform

Elizabeth J Williamson et al. BMJ. .

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.

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Conflict of interest statement

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.

Figures

Fig 1
Fig 1
Cumulative covid-19 related deaths, and covid-19 related hospital admissions and deaths with 95% confidence intervals for adults aged ≥16 years through two waves of infection. People on learning disability register and those not on register shown separately. Estimates are standardised by age, sex, and ethnicity
See this image and copyright information in PMC

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