Risk Factors Associated With COVID-19 Outcomes Among People With Intellectual and Developmental Disabilities Receiving Residential Services

Scott D. Landes,Philip Proctor,Sarah Baier,Margaret A. Turk,Marco R. Damiani

doi:10.1001/jamanetworkopen.2021.12862

Scott D. Landes, Philip Proctor + Show 3 more

Open Access

https://doi.org/10.1001/jamanetworkopen.2021.12862

Copy DOI

Abstract

Although there is evidence of more severe COVID-19 outcomes, there is no information describing the risk factors for COVID-19 diagnosis and/or mortality among people with intellectual and developmental disabilities (IDD) receiving residential support services in the US. To identify associations between demographic characteristics, residential characteristics, and/or preexisting health conditions and COVID-19 diagnosis and mortality for people with IDD receiving residential support services. This cohort study tracked COVID-19 outcomes for 543 individuals with IDD. Participants were receiving support services from a single organization providing residential services in the 5 boroughs of New York City from March 1 to October 1, 2020. Statistical analysis was performed from December 2020 to February 2021. Resident-level characteristics, including age, sex, race/ethnicity, disability status, residential characteristics, and preexisting medical conditions. COVID-19 diagnosis was confirmed by laboratory test. COVID-19 mortality indicated that the individual died from COVID-19 during the course of the study. Logistic regression models were used to evaluate associations between demographic characteristics, residential characteristics, and preexisting health conditions and COVID-19 diagnosis and mortality. Among the 543 individuals with IDD in the study, the median (interquartile range) age was 57.0 (45-65) years; 217 (40.0%) were female, and 274 (50.5%) were Black, Asian/Pacific Islander, American Indian or Alaskan Native, or Hispanic. The case rate was 16 759 (95% CI, 13 853-20 131) per 100 000; the mortality rate was 6446 (95% CI, 4671-8832) per 100 000; and the case-fatality rate was 38.5% (95% CI, 29.1%-48.7%). Increased age (odds ratio [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, 1.00-1.14), and chronic kidney disease (OR, 4.17; 95% CI, 1.90-9.15) were associated with COVID-19 diagnosis. Heart disease (OR, 10.60; 95% CI, 2.68-41.90) was associated with COVID-19 mortality. This study found that, similar to the general population, increased age and preexisting health conditions were associated with COVID-19 outcomes for people with IDD receiving residential support services in New York City. As with older adults living in nursing homes, number of residents was also associated with more severe COVID-19 outcomes. Unique to people with IDD was an increased risk of COVID-19 diagnosis for people with Down syndrome.

Highlights

There is mounting empirical evidence that people with intellectual and developmental disabilities (IDD) in the US, a vulnerable health population,[1] are experiencing more severe COVID-19 outcomes than the general population
This study found that, similar to the general population, increased age and preexisting health conditions were associated with COVID-19 outcomes for people with IDD receiving residential support services in New York City
As with older adults living in nursing homes, number of residents was associated with more severe COVID-19 outcomes

Summary

Introduction

There is mounting empirical evidence that people with intellectual and developmental disabilities (IDD) in the US, a vulnerable health population,[1] are experiencing more severe COVID-19 outcomes than the general population. An early study using real-time electronic medical record data for individuals diagnosed with COVID-19 reported that people with IDD had higher prevalence of comorbidities (respiratory diseases; endocrine, nutritional, and metabolic diseases; and circulatory diseases) associated with more severe COVID-19 outcomes, and had a higher case-fatality rate at ages 0 to years and to 74 years.[2] A second study using data for New York State reported that the COVID-19 case rate was 4.1 times higher and case-fatality rate 1.9 times higher for people with IDD living in residential group homes than for the state overall.[3] A more recent study used data from California and reported that the COVID-19 outcomes for people with IDD varied by residential setting, with higher case rates in settings with more residents and higher case-fatality rates in settings providing skilled nursing care.[4]. It is possible that similar to older adults living in nursing homes, people with IDD receiving direct, difficult-to-physically distance support in certain congregate settings,[14,15,16] especially those with a greater number of residents,[17,18] may be at greater risk during the pandemic.[4,19] Unique to people with IDD, one study from the UK identified people with Down syndrome, a particular type of IDD, may be at increased risk of COVID-19 death.[20]

Methods

Results

Discussion

Conclusion