Multiple physical and mental health comorbidity in adults with intellectual disabilities: population-based cross-sectional analysis

Abstract

BackgroundAdults with intellectual disabilities have increased early mortality compared with the general population. However, their extent of multimorbidity (two or more additional conditions) compared with the general population is unknown, particularly with regards to physical ill-health, as are associations between comorbidities, neighbourhood deprivation, and age.MethodsWe analysed primary health-care data on 1,424,378 adults registered with 314 representative Scottish practices. Data on intellectual disabilities, 32 physical, and six mental health conditions were extracted. We generated standardised prevalence rates by age-groups, gender, and neighbourhood deprivation, then calculated odds ratio (OR) and 95 % confidence intervals (95 % CI) for adults with intellectual disabilities compared to those without, for the prevalence, and number of condition.ResultsEight thousand fourteen (0.56 %) had intellectual disabilities, of whom only 31.8 % had no other conditions compared to 51.6 % without intellectual disabilities (OR 0.26, 95 % 0.25–0.27). The intellectual disabilities group were significantly more likely to have more conditions, with the biggest difference found for three conditions (10.9 % versus 6.8 %; OR 2.28, 95 % CI 2.10–2.46). Fourteen physical conditions were significantly more prevalent, and four cardiovascular conditions occurred less frequently, as did any cancers, and chronic obstructive pulmonary diseases. Five of the six mental health conditions were significantly more prevalent. For the adults with intellectual disabilities, no gradient was seen in extent of multimorbidity with increasing neighbourhood deprivation; indeed findings were similar in the most affluent and most deprived areas. Co-morbidity increased with age but is highly prevalent at all ages, being similar at age 20–25 to 50–54 year olds in the general population.ConclusionsMulti-morbidity burden is greater, occurs at much earlier age, and the profile of health conditions differs, for adults with intellectual disabilities compared with the general population. There is no association with neighbourhood deprivation; people with intellectual disabilities need focussed services irrespective of where they live, and at a much earlier age than the general population. They require specific initiatives to reduce inequalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0329-3) contains supplementary material, which is available to authorized users.

An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

“…These studies considered a wider range of conditions than our study and, as a result, reported higher levels of multimorbidity than we did. This makes any direct comparison difficult; however, the relative doubling of multimorbidity (defined as two or more conditions) between adults with and adults without ID in the Scottish study 92 were similar to our findings, in which adults with ID were 1.8 times more likely to have multiple QOF conditions. The Dutch study finding of greater multimorbidity among adults with Down syndrome 91 was the opposite of what we found, presumably owing to this study involving older adults only (≥ 50 years), whereas our patients with Down syndrome were primarily younger (73% were < 50 years old).…”

“…94 Our high prevalence of recorded mental health problems such as schizophrenia (6.8%) is similar to that found in the Scottish primary care study (5.6%), 92 and consistent with an earlier population-based survey 95 undertaken in Glasgow in the early 2000s, which found that 4.4% of 1023 adults with ID received a clinical diagnosis of a psychotic disorder, including schizophrenia. Although the recording of depression ever in the patient record for adults with ID (18%) was similar to that reported in the Scottish primary care study (16%), 92 we found no difference when compared with our matched controls, whereas in Scotland adults with ID were significantly more likely to have a diagnosis than population controls. 92 When we restricted to diagnoses made in the last year, we actually found that adults with ID were less likely to receive a depression diagnosis.…”

“…Only a recent Scottish study in primary care of 8014 adults with ID has been able to provide comprehensive standardised prevalence rates by age groups, 92 and produced findings for 2007 similar to our own published findings for 2012. 66 In addition, the recent studies in Scotland, 92 Ireland 83 and the Netherlands 91 have all considered multimorbidity in adults with ID. These studies considered a wider range of conditions than our study and, as a result, reported higher levels of multimorbidity than we did.…”

“…92 Both are lower than an estimate of 26% found in Leicestershire from a regionally based register in 2006, 18 but this may reflect regional and methodological differences. There has also been a concern that epilepsy has been historically overdiagnosed in people with ID, estimated at around 3 in 10 from a review in 2011, 93 and so our more recent findings may represent an improvement in diagnosis.…”

“…19,20,83,[88][89][90][91][92] These have shown high levels of comorbidity, although direct comparisons of estimated prevalence with the general population has generally been difficult owing to population selection and disease definition. Only a recent Scottish study in primary care of 8014 adults with ID has been able to provide comprehensive standardised prevalence rates by age groups, 92 and produced findings for 2007 similar to our own published findings for 2012. 66 In addition, the recent studies in Scotland, 92 Ireland 83 and the Netherlands 91 have all considered multimorbidity in adults with ID.…”