Increased age and preexisting health conditions affected COVID-19 outcomes among people with intellectual and developmental disabilities, according to results of a cohort study published in JAMA Network Open.
“To better understand COVID-19 outcomes among people with [intellectual and developmental disabilities], the present study used a sample of adults [in this population] receiving residential support services in New York City, the epicenter of the pandemic in the U.S.,” Scott D. Landes, PhD, of the department of sociology and the Aging Studies Institute at Syracuse University’s Maxwell School of Citizenship and Public Affairs in New York, and colleagues wrote. “Based upon the results of prior studies, we hypothesized that more severe COVID-19 outcomes would be associated with increased age, residential characteristics, Down syndrome and preexisting health conditions.”
The researchers aimed to pinpoint links between demographic characteristics, residential characteristics and/or preexisting health conditions and COVID-19 diagnosis and mortality among individuals with intellectual and developmental disabilities who received residential support services. They tracked outcomes of 543 individuals in this patient population who received support services from a single organization that provided residential services in New York City’s five boroughs between March 1, 2020, and Oct. 1, 2020. Resident-level characteristics, such as age, sex, race/ethnicity, disability status, residential characteristics and preexisting medical conditions served as exposures. COVID-19 diagnosis confirmed via laboratory test and COVID-19 mortality indicating that the individual died from COVID-19 during the course of the study served as the main outcomes and measures.
Landes and colleagues used logistic regression models to assess links between demographic characteristics and residential characteristics, as well as preexisting health conditions and COVID-19 diagnosis and mortality. Participants had a mean age of 57 years, 40% were women and 50.5% were Black, Asian/Pacific Islander, American Indian or Alaskan Native or Hispanic.
Results showed a case rate of 16,759 (95% CI, 13,853-20,131) per 100,000 and a mortality rate of 6,446 (95% CI, 4,671-8,832) per 100,000, with a case-fatality rate of 38.5% (95% CI, 29.1-48.7). Factors associated with COVID-19 diagnosis included increased age (OR = 1.04; 95% CI, 1.02-1.06), Down syndrome (OR = 2.91; 95% CI, 1.49-5.69), an increased number of residents (OR = 1.07; 95% CI, 1-1.14) and chronic kidney disease (OR = 4.17; 95% CI, 1.9-9.15). Heart disease (OR = 10.6; 95% CI, 2.68-41.9) was linked to COVID-19 mortality.
“The substantially higher case rate and case-fatality rate reported for people with [intellectual and developmental disabilities] in this study further emphasizes the necessity to prioritize this population for COVID-19 vaccine allocation,” Landes and colleagues wrote. “In addition, results underscore that COVID-19 diagnosis should prompt close monitoring and consideration of hospitalization if respiratory symptoms develop for all people with [intellectual and developmental disabilities], but especially for those who are older, have preexisting medical conditions and/or Down syndrome or live in settings with more residents.
“Standard preventive measures must be employed,” the researchers added. “But the additional risks reported in this study suggest that it may be necessary to adapt the unique basic and complex daily living care and support needs that exist in community-based congregate living arrangements for people with [intellectual and developmental disabilities] in ways that minimize infection risk [for] residents and staff.”