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COVID-19 infection and outcomes in a population-based cohort of 17 203 adults with intellectual disabilities compared with the general population
  1. Angela Henderson1,
  2. Michael Fleming1,
  3. Sally-Ann Cooper1,
  4. Jill P Pell1,
  5. Craig Melville1,
  6. Daniel F Mackay1,
  7. Chris Hatton2,
  8. Deborah Kinnear1
  1. 1 Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  2. 2 Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
  1. Correspondence to Mrs Angela Henderson, Institute of Health and Wellbeing, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow G12 8QQ, UK; Angela.Henderson{at}


Background Adults with intellectual disabilities (ID) may be at higher risk of COVID-19 death. We compared COVID-19 infection, severe infection, mortality, case fatality and excess deaths, among adults with, and without, ID.

Methods Adults with ID in Scotland’s Census, 2011, and a 5% sample of other adults, were linked to COVID-19 test results, hospitalisation data and deaths (24 January 2020–15 August 2020). We report crude rates of COVID-19 infection, severe infection (hospitalisation/death), mortality, case fatality; age-standardised, sex-standardised and deprivation-standardised severe infection and mortality ratios; and annual all-cause mortality for 2020 and 2015–2019.

Findings Successful linkage of 94.9% provided data on 17 203 adults with, and 188 634 without, ID. Adults with ID had more infection (905/100 000 vs 521/100 000); severe infection (538/100 000 vs 242/100 000); mortality (258/100 000 vs 116/100 000) and case fatality (30% vs 24%). Poorer outcomes remained after standardisation: standardised severe infection ratio 2.61 (95% CI 1.81 to 3.40) and mortality ratio 3.26 (95% CI 2.19 to 4.32). These were higher at ages 55–64: 7.39 (95% CI 3.88 to 10.91) and 19.05 (95% CI 9.07 to 29.02), respectively, and in men, and less deprived neighbourhoods. All-cause mortality was slightly higher in 2020 than 2015–2019 for people with ID: standardised mortality ratio 2.50 (95% CI 2.18 to 2.82) and 2.39 (95% CI 2.28 to 2.51), respectively.

Conclusion Adults with ID had more COVID-19 infections, and worse outcomes once infected, particularly adults under 65 years. Non-pharmaceutical interventions directed at formal and informal carers are essential to reduce transmission. All adults with ID should be prioritised for vaccination and boosters regardless of age.

  • disabled persons
  • COVID-19
  • death
  • epidemiology
  • health inequalities

Data availability statement

No data are available. Not applicable.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

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  • Contributors AH and DK conceived the study. AH and S-AC led on the acquisition of data for the study. AH, DK, MF, JPP, S-AC, DFM, CM and CH were involved in the design of the study and interpretation of the data. MF led the analysis of the data and CM verified data. AH and DK prepared the first draft of the manuscript. MF, JPP, S-AC, DFM, CM and CH also contributed to the manuscript writing. All authors approved the final manuscript. AH is the study guarantor.

  • Funding This study was funded by Scottish Government via the Scottish Learning Disabilities Observatory.

  • Competing interests None declared.

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