Risks of covid-19 hospital admission and death for people with learning disability: population based cohort study using the OpenSAFELY platform
Authors: Williamson Elizabeth J , McDonald Helen I , Bhaskaran Krishnan , Walker Alex J , Bacon Sebastian , Davy Simon , Schultze Anna , Tomlinson Laurie , Bates Chris , Ramsay Mary , Curtis Helen J , Forbes Harriet , Wing Kevin , Minassian Caroline , Tazare John , Morton Caroline E , Nightingale Emily , Mehrkar Amir , Evans Dave , Inglesby Peter , MacKenna Brian , Cockburn Jonathan , Rentsch Christopher T , Mathur Rohini , Wong Angel Y S , Eggo Rosalind M , Hulme William , Croker Richard , Parry John , Hester Frank , Harper Sam , Douglas Ian J , Evans Stephen J W , Smeeth Liam , Goldacre Ben , Kuper Hannah 
Published: July 2021

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.