Mortality rates in people with intellectual disabilities IJPDS (2017) Issue 1, Vol 1:312 Proceedings of the IPDLN Conference (August 2016)

Main Article Content

Rachael Williams
Jessie Oyinlola
Pauline Heslop
Gyles Glover
Published online: Apr 19, 2017


ABSTRACT

Objectives
A growing body of evidence highlights a disparity in mortality rates for people with intellectual disability (ID) compared with the general population. However, national data for England is lacking. The objective of this study was to provide evidence on mortality rates in people with ID.


Approach
Patients registered for at least a day during 01/04/10-31/03/14 at a GP practice contributing to the Clinical Practice Research Datalink (CPRD) and consenting to linkage were included. Patients with ID were identified via Read codes. Date and cause of death were identified using linked Office of National
Statistics mortality data. Crude mortality rates, life expectancy and indirectly age/sex standardised mortality ratios (SMR) were calculated with 95% confidence intervals (CI), overall, by ICD10 chapter, for frequently occurring causes, and those classified as avoidable.


Results
11 million person-years were included (0.5% for patients with ID) and 98,035 deaths occurred (0.7% in patients with ID). The mortality rate for patients with ID was 11.2 per 1,000 population, 1.3 times the rate for those without ID, with an associated SMR of 3.2 (95% CI 2.93.4). Life expectancy was 65.5
years (95% CI 61.969.2)for patients with ID and 85.3 years for those without (95% CI 85.285.4). Mortality rates were higher in patients with ID in all age/sex groups, with larger differences for younger ages. Patients with ID had higher cause-specific mortality rates across all ICD10 chapters, with highest SMRs for congenital malformations (72.9, 95% CI 55.194.7), nervous system diseases (9.8, 95% CI 7.812.1) and mental disorders (5.4, 95% CI 3.97.3). Circulatory deaths were the most frequent, with ischaemic heart disease (SMR 2.2, 95% CI 1.62.8) and cerebrovascular disease (SMR 3.3, 95% CI 2.34.5) most prominent. A higher proportion of deaths were classified as avoidable for patients with ID (44.7%,
95% CI 41.048.5%) compared to those without (21.0%, 95% CI 20.721.3).


Conclusion
National English data confirm that patients with ID have higher mortality rates than those without. Mortality rates for patients with ID were higher across all age/sex groups and causes, with almost half of deaths classified as avoidable.


Objective

Electronic health records are increasingly used to investigate associations between antidiabetic therapy and cancer. Misclassification can impact results, especially if differential between comparators. The objective of this study was to estimate cancer misclassification when using primary care or hospital data alone.

Methods

Adults aged \(\geq\)40 years with an insulin or oral antidiabetic prescription in Clinical Practice Research Datalink (CPRD) primary care data at least a year after start of data collection, and no record of type 1 diabetes, were included. Patients were matched by year of birth (stepwise within 5 years), sex and GP practice to up to 1 non-diabetic patient. The cohort was restricted to those eligible for Hospital Episode Statistics (HES) linkage with follow-up during the study period (01/04/97-31/12/06). Follow-up started at the maximum of the registration date with the practice, practice up-to-standard date (a CPRD quality metric), and start of study period. Follow-up ended at the minimum of when the patient left the practice, the date CPRD last collected data from the practice, and end of study period. Cancer was identified in CPRD via Read codes and in HES via ICD10 codes. For each cancer case in CPRD, analysis evaluated whether there was a corresponding record in HES coded with same, different or unspecified site. Analysis was repeated for cancers identified in HES.

Results

53,585 diabetic patients were matched to 47,435 non-diabetic patients. 83% of cancer cases in CPRD had a corresponding record in HES (78% with the same type). Misclassification varied by cancer site, ranging from 3% (stomach cancer) to 57% (nonmelanoma skin cancer). 83% of cancer cases in HES had a corresponding record in CPRD, with all misclassification rates <20%.

Conclusion

A good level of concordance and low level of misclassification of cancer exist between CPRD primary care data and HES. The value of linking these data for establishing cancer outcomes lies more in the complimentary variables held than in reducing misclassification.

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