The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study
The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study
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DOI：
10.1016/s0140-6736(13)62026-7
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发表时间：
2014-03-08
期刊：
影响因子：
168.9
通讯作者：
Russ, Lesley
中科院分区：
文献类型：
--
作者：
Heslop, Pauline;Blair, Peter S.;Russ, Lesley
背景 对英格兰智障人士过早死亡的保密调查的目的是提供有关该人群中可避免的过早死亡的促成因素的证据。方法以人口为基础的保密调查审查了 4 岁及以上智障人士的死亡情况，这些人曾在英格兰西南部五个初级保健信托地区之一的全科医生处登记，这些人于 2010 年 6 月 1 日至 2012 年 5 月 31 日期间死亡。社会关怀和志愿部门服务；社区联系；法定机构向保密调查通报了所有智障人士的死亡情况并提供了核心数据。国家统计局提供了有关个人死因证明编码的数据。根据国家统计局的定义，死亡被描述为可以避免（可预防或可应对）的。造成死亡的因素由案件调查员确定和量化，由当地审查小组会议验证，并得到保密调查概述小组的同意。贡献因素分为四个领域：个人固有的、家庭和环境内的、护理提供和服务提供。还对一组无智力障碍者的死亡进行了调查，但年龄、性别和死因与智力障碍者的年龄、性别和死因大致相同，并在相同的常规诊所进行了登记。调查结果 机密调查审查了 247 名智力障碍者的死亡情况。近四分之一（22%，54）智障人士死亡时年龄小于 50 岁，死亡中位年龄为 64 岁（IQR 52-75）。智力障碍男性的平均死亡年龄为 65 岁（IQR 54-76），比英格兰和威尔士普通人口男性的平均死亡年龄（78 岁）小 13 岁。智力障碍女性的平均死亡年龄为 63 岁（IQR 54-75），比一般人群女性的平均死亡年龄（83 岁）小 20 岁。智力障碍者（244 人中的 90 人，占 37%）中因可通过优质医疗保健改变的原因导致的可避免的死亡比英格兰和威尔士的普通人群（13%）更为常见。与非智力障碍人群相比，一部分智力障碍人群过早死亡的影响因素包括高级护理计划中的问题 (p=0.0003)、遵守《心智能力法案》(p=0.0008)、居住在不适当的住处 (p=0.0003)
Background The Confidential Inquiry into premature deaths of people with intellectual disabilities in England was commissioned to provide evidence about contributory factors to avoidable and premature deaths in this population.Methods The population-based Confidential Inquiry reviewed the deaths of people with intellectual disabilities aged 4 years and older who had been registered with a general practitioner in one of five Primary Care Trust areas of southwest England, who died between June 1, 2010, and May 31, 2012. A network of health, social-care, and voluntary-sector services; community contacts; and statutory agencies notified the Confidential Inquiry of all deaths of people with intellectual disabilities and provided core data. The Office for National Statistics provided data about the coding of individual cause of death certificates. Deaths were described as avoidable (preventable or amenable), according to Office for National Statistics definitions. Contributory factors to deaths were identified and quantified by the case investigator, verified by a local review panel meeting, and agreed by the Confidential Inquiry overview panel. Contributory factors were grouped into four domains: intrinsic to the individual, within the family and environment, care provision, and service provision. The deaths of a comparator group of people without intellectual disabilities but much the same in age, sex, and cause of death and registered at the same general practices as those with intellectual disabilities were also investigated.Findings The Confidential Inquiry reviewed the deaths of 247 people with intellectual disabilities. Nearly a quarter (22%, 54) of people with intellectual disabilities were younger than 50 years when they died, and the median age at death was 64 years (IQR 52-75). The median age at death of male individuals with intellectual disabilities was 65 years (IQR 54-76), 13 years younger than the median age at death of male individuals in the general population of England and Wales (78 years). The median age at death of female individuals with intellectual disabilities was 63 years (IQR 54-75), 20 years younger than the median age at death for female individuals in the general population (83 years). Avoidable deaths from causes amenable to change by good quality health care were more common in people with intellectual disabilities (37%, 90 of 244) than in the general population of England and Wales (13%). Contributory factors to premature deaths in a subset of people with intellectual disabilities compared with a comparator group of people without intellectual disabilities included problems in advanced care planning (p=0.0003), adherence to the Mental Capacity Act (p=0.0008), living in inappropriate accommodation (p