Mortality in people with intellectual disabilities in England
Mortality in people with intellectual disabilities in England
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DOI：
10.1111/jir.12314
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发表时间：
2017-01-01
影响因子：
3.6
通讯作者：
Grey, J.
中科院分区：
文献类型：
--
作者：
Glover, G.;Williams, R.;Grey, J.
Backgroundpeople with intellectual disabilities（IDS）die at young ages than the general population，but national representative and international comparable mortality data about people with ID，quantifying the extent and pattern of the excess，have not previously been reported for England.MethodWe used data from the Clinical Practice Research Datalink database for April 2010 to March 2014（CPRD GOLD September 2015）.这一来源涵盖了数百个参与的一般做法，包括大约5%的人口在英格兰的研究期间。全科医生（GP）的记录确定了他们的GP诊断为ID. Linked国家死亡认证数据的人，使我们能够获得相应的死亡率数据与ID和没有ID的人，整体和cause.ResultsMortality率ID的人显着高于那些没有。他们的全因标准化死亡率为3.18。他们出生时的预期寿命比没有身份证的人低19.7岁，循环和呼吸系统疾病以及肿瘤是他们最常见的三个死亡原因。脑血管疾病、血栓性静脉炎和肺栓塞在ID患者中的标准化死亡率均大于3。其他可能避免的原因包括癫痫（占死亡人数的3.9%）、吸入性肺炎（3.6%）和结直肠癌（2.4%）。避免死亡率分析显示，与没有ID的人相比，被归类为适合良好医疗护理的原因导致的死亡比例较高，但可预防原因的比例较低。与数据已公布的足够详细的地区进行国际比较，以计算直接标准化率，表明英格兰ID患者的死亡率可能高于加拿大和芬兰的地区。和较低的死亡率比爱尔兰或美国的马萨诸塞州。ConclusionsNational数据ID的人的死亡率提供了一个基础，公共卫生干预措施。使用全科医生记录来识别ID患者的关联数据可以在英格兰提供全面的基于人口的监测，不受疾病或死亡情况的影响;迄今为止，信息治理限制阻止了这一点。然而，英国的全科医生目前仅识别出约0.5%的人口患有ID，这表明患有轻度，非综合征型ID的个体在很大程度上被遗漏了。值得注意的是，常见的死亡原因表明，控制心血管风险因素、癫痫和吞咽困难、管理血栓形成风险和结肠直肠筛查是健康促进举措的重要领域。
BackgroundPeople with intellectual disabilities (IDs) die at younger ages than the general population, but nationally representative and internationally comparable mortality data about people with ID, quantifying the extent and pattern of the excess, have not previously been reported for England.MethodWe used data from the Clinical Practice Research Datalink database for April 2010 to March 2014 (CPRD GOLD September 2015). This source covered several hundred participating general practices comprising roughly 5% of the population of England in the period studied. General practitioner (GP) records identified people diagnosed by their GP as having ID. Linked national death certification data allowed us to derive corresponding mortality data for people with and without ID, overall and by cause.ResultsMortality rates for people with ID were significantly higher than for those without. Their all-cause standardised mortality ratio was 3.18. Their life expectancy at birth was 19.7years lower than for people without ID. Circulatory and respiratory diseases and neoplasms were the three most common causes of death for them. Cerebrovascular disease, thrombophlebitis and pulmonary embolism all had standardised mortality ratios greater than 3 in people with ID. This has not been described before. Other potentially avoidable causes included epilepsy (3.9% of deaths), aspiration pneumonitis (3.6%) and colorectal cancer (2.4%). Avoidable mortality analysis showed a higher proportion of deaths from causes classified as amenable to good medical care but a lower proportion from preventable causes compared with people without ID. International comparison to areas for which data have been published in sufficient detail for calculation of directly standardised rates suggest England may have higher death rates for people with ID than areas in Canada and Finland, and lower death rates than Ireland or the State of Massachusetts in the USA.ConclusionsNational data about mortality in people with ID provides a basis for public health interventions. Linked data using GP records to identify people with ID could provide comprehensive population-based monitoring in England, unbiased by the circumstances of illnesses or death; to date information governance constraints have prevented this. However, GPs in England currently identify only around 0.5% of the population as having ID, suggesting that individuals with mild, non-syndromic ID are largely missed. Notably common causes of death suggest control of cardiovascular risk factors, epilepsy and dysphagia, management of thrombotic risks and colorectal screening are important areas for health promotion initiatives.