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Original research
Mortality disparities and deprivation among people with intellectual disabilities in England: 2000–2019
  1. Freya Tyrer1,
  2. Richard Morriss2,
  3. Reza Kiani3,
  4. Satheesh K Gangadharan3,
  5. Mark J Rutherford1
  1. 1 Department of Health Sciences, University of Leicester, Leicester, UK
  2. 2 Institute of Mental Health, University of Nottingham, Nottingham, UK
  3. 3 Intellectual Disability Psychiatry Department, Leicestershire Partnership NHS Trust, Leicester, UK
  1. Correspondence to Freya Tyrer, Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK; fct2{at}le.ac.uk

Abstract

Background The effect of policy initiatives and deprivation on mortality disparities in people with intellectual disabilities is not clear.

Methods An electronic health record observational study of linked primary care data in England from the Clinical Practice Research Datalink and the Office for National Statistics deaths data from 2000 to 2019 was undertaken. All-cause and cause-specific mortality for people with intellectual disabilities were calculated by gender and deprivation status (index of multiple deprivation quintile) using direct age-standardised mortality rates (all years) and ratios (SMR; 2000–2009 vs 2010–2019).

Results Among 1.0 million patients (n=33 844 with intellectual disability; n=980 586 general population without intellectual disability), differential mortality was consistently higher in people with intellectual disabilities and there was no evidence of attenuation over time. There was a dose–response relationship between all-cause mortality and lower deprivation quintile in the general population which was not observed in people with intellectual disabilities. Cause-specific SMR were consistent in both the 2000–2009 and 2010–2019 calendar periods, with a threefold increased risk of death in both males and females with intellectual disabilities (SMR ranges: 2.91–3.51). Mortality was highest from epilepsy (SMR ranges: 22.90–52.74) and aspiration pneumonia (SMR ranges: 19.31–35.44). SMRs were disproportionately high for people with intellectual disabilities living in the least deprived areas.

Conclusions People with intellectual disabilities in England continue to experience significant mortality disparities and there is no evidence that the situation is improving. Deprivation indicators may not be effective for targeting vulnerable individuals.

  • learning disability
  • deprivation
  • mortality
  • public health
  • epidemiology

Data availability statement

Data may be obtained from a third party and are not publicly available. The data used for this study involve an extract from an established research database, the Clinical Practice Research Datalink (CPRD) with linked mortality data from the Office for National Statistics. The data controller for the CPRD is the Department of Health and Social Care.

https://doi.org/10.1136/jech-2021-216798

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The data used for this study involve an extract from an established research database, the Clinical Practice Research Datalink (CPRD) with linked mortality data from the Office for National Statistics. The data controller for the CPRD is the Department of Health and Social Care.

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    Footnotes

    • Correction notice This article has been corrected since it first published. There was a typographical error in the supplementary material for the footnote of page s15 (n=131 now reads n=31).

    • Contributors FT and MR contributed to the planning, conduct, design, reporting of the work, funding acquisition, data acquisition and analysis and interpretation of data for this work. RM, SKG and RK contributed to the planning, conduct, interpretation of data and reporting.

    • Funding This study was funded from a Baily Thomas Doctoral Fellowship award (TRUST/VC/AC/SG/5366-8393). We gratefully acknowledge Professor Panos Vostanis for his helpful comments on this manuscript. We would like to acknowledge the carers and service users who have been involved in this programme of work by discussing their own health related experiences, in particular: the Charnwood Action Group; the Talk and Listen Group; Gill Huddleston; Kate Dolan; Sarah Stanyer and Amy Stanway.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.