London School of Hygiene & Tropical Medicine

People with learning disabilities with COVID-19 are five times more likely to be admitted to hospital and eight times more likely to die compared with the general population of England, according to a new study in The BMJ.

Led by the London School of Hygiene & Tropical Medicine (LSHTM) and the University of Oxford, the research found risks were particularly high for those with severe to profound learning disability, Down’s syndrome and cerebral palsy.

The researchers say prompt access to COVID-19 testing and healthcare is warranted for this group, and prioritisation for COVID-19 vaccination and other targeted preventive measures should be considered.

Professor Hannah Kuper from LSHTM and senior author of the study, said: "The findings from our study show that people with learning disabilities are at starkly increased risk of adverse risks from COVID-19, including unfortunately death. We are delighted that this study contributed towards the decision of JCVI to change its recommendation and include all people on the learning disability register for vaccine prioritization.

“We hope that other countries will tailor their guidance on COVID-19 vaccination, and other preventive efforts, accordingly. There is now a clear need to expand the Learning Disability register to include all eligible people."

Emerging evidence has shown that people with learning disability are at higher risk from COVID-19 related death compared with the general population. But results from existing studies on other COVID-19 outcomes are often complicated by factors such as deprivation and underlying conditions (comorbidities).

A lack of clarity also exists on the increased risk of COVID-19 deaths among people with milder learning disability.

To explore this further, a team of UK researchers set out to describe the risk of COVID-19 related hospital admissions and deaths among children and adults with learning disability in England compared with the general population.

Their results are based on electronic health records for more than 17 million people registered with a general practice in England linked to hospital admission and mortality data.

Data for 14,312,023 adults and 2,627,018 children were analysed across both waves of the COVID-19 pandemic: wave 1 (registered with a general 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).

Among 90,307 adults on the learning disability 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-related deaths and 69,837 (0.5%) non-COVID deaths.

After taking account of potentially influential factors, such as age, sex, ethnicity, and geographical location, adults on the learning disability register had a 5-fold higher risk of COVID-19 related hospital admission and an 8-fold higher risk of COVID-19 related death than adults not on the register.

Rates were higher among those with severe to profound learning disability than those with milder learning disability, and among those in residential care.

Similar patterns were seen for children, but the authors stress that absolute risks of COVID-19 hospital admission and death among children were small.

These are observational findings and the authors point to some limitations, such as focusing only on severe COVID-19 outcomes and being unable to identify everyone with a learning disability from medical records alone. Nevertheless, results were similar after further analyses, and are consistent with the existing literature, suggesting that they are robust.

The findings also highlight gaps in learning disability registers, limiting the reach of the vaccination programme, prompting a call for greater efforts to update and maintain accurate registers so that all eligible individuals can benefit.

Besides vaccination, efforts should continue to protect people with learning disability from COVID-19 adverse outcomes, and more research on the excess COVID-19 risks among people with Down’s syndrome and cerebral palsy are needed, they conclude.

Publication

Elizabeth J Williamson et al. Risks of COVID-19 hospital admission and death for people with learning disability: population based cohort study using the OpenSAFELY platform. The BMJ. DOI: 10.1136/bmj.n1592