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Nielsen TC, Nassar N, Boulton KA, Guastella AJ, Lain SJ. Estimating the Prevalence of Autism Spectrum Disorder in New South Wales, Australia: A Data Linkage Study of Three Routinely Collected Datasets. J Autism Dev Disord 2024; 54:1558-1566. [PMID: 36652127 PMCID: PMC10981615 DOI: 10.1007/s10803-022-05887-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 01/19/2023]
Abstract
Routinely collected data help estimate the prevalence of autism spectrum disorder (ASD) in jurisdictions without active autism surveillance. We created a population-based cohort of 1,211,834 children born in 2002-2015 in New South Wales, Australia using data linkage. Children with ASD were identified in three datasets - disability services, hospital admissions, and ambulatory mental health data. The prevalence of ASD in the cohort was 1.3% by age 12 and prevalence at age 6 increased an average of 4.1% per year (95% Confidence Interval, 3.3%, 4.8%). Most children with ASD were identified in disability services data (87%), although data linkage identified 1,711 additional cases that were more likely female, older at first contact, and living in major cities and less disadvantaged areas.
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Affiliation(s)
- Timothy C Nielsen
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Natasha Nassar
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Kelsie A Boulton
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Adam J Guastella
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Samantha J Lain
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
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Zondlak AN, Oh EJ, Neiman PU, Fan Z, Taylor KK, Sangji NF, Hemmila MR, Scott JW. Association of Intellectual Disability with Delayed Presentation and Worse Outcomes in Emergency General Surgery. Ann Surg 2023; 278:e1118-e1122. [PMID: 36994738 DOI: 10.1097/sla.0000000000005863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To examine the association between intellectual disability and both severity of disease and clinical outcomes among patients presenting with common emergency general surgery (EGS) conditions. BACKGROUND Accurate and timely diagnosis of EGS conditions is crucial for optimal management and patient outcomes. Individuals with intellectual disabilities may be at increased risk of delayed presentation and worse outcomes for EGS; however, little is known about surgical outcomes in this population. METHODS Using the 2012-2017 Nationwide Inpatient Sample, we conducted a retrospective cohort analysis of adult patients admitted for 9 common EGS conditions. We performed multivariable logistic and linear regression to examine the association between intellectual disability and the following outcomes: EGS disease severity at presentation, any surgery, complications, mortality, length of stay, discharge disposition, and inpatient costs. Analyses were adjusted for patient demographics and facility traits. RESULTS Of 1,317,572 adult EGS admissions, 5,062 (0.38%) patients had a concurrent ICD-9/-10 code consistent with intellectual disability. EGS patients with intellectual disabilities had 31% higher odds of more severe disease at presentation compared with neurotypical patients (aOR 1.31; 95% CI 1.17-1.48). Intellectual disability was also associated with a higher rate of complications and mortality, longer lengths of stay, lower rate of discharge to home, and higher inpatient costs. CONCLUSION EGS patients with intellectual disabilities are at increased risk of more severe presentation and worse outcomes. The underlying causes of delayed presentation and worse outcomes must be better characterized to address the disparities in surgical care for this often under-recognized but highly vulnerable population.
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Affiliation(s)
- Allyse N Zondlak
- University of Michigan Medical School, Ann Arbor, MI
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Esther J Oh
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Pooja U Neiman
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Zhaohui Fan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Kathryn K Taylor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, Stanford University, Stanford, CA
| | - Naveen F Sangji
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Mark R Hemmila
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - John W Scott
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
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Sheehan R, Mansour H, Broadbent M, Hassiotis A, Mueller C, Stewart R, Strydom A, Sommerlad A. Recording of intellectual disability in general hospitals in England 2006-2019: Cohort study using linked datasets. PLoS Med 2023; 20:e1004117. [PMID: 36940198 PMCID: PMC10069786 DOI: 10.1371/journal.pmed.1004117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/03/2023] [Accepted: 02/20/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Accurate recognition and recording of intellectual disability in those who are admitted to general hospitals is necessary for making reasonable adjustments, ensuring equitable access, and monitoring quality of care. In this study, we determined the rate of recording of intellectual disability in those with the condition who were admitted to hospital and factors associated with the condition being unrecorded. METHODS AND FINDINGS Retrospective cohort study using 2 linked datasets of routinely collected clinical data in England. We identified adults with diagnosed intellectual disability in a large secondary mental healthcare database and used general hospital records to investigate recording of intellectual disability when people were admitted to general hospitals between 2006 and 2019. Trends over time and factors associated with intellectual disability being unrecorded were investigated. We obtained data on 2,477 adults with intellectual disability who were admitted to a general hospital in England at least once during the study period (total number of admissions = 27,314; median number of admissions = 5). People with intellectual disability were accurately recorded as having the condition during 2.9% (95% CI 2.7% to 3.1%) of their admissions. Broadening the criteria to include a nonspecific code of learning difficulty increased recording to 27.7% (95% CI 27.2% to 28.3%) of all admissions. In analyses adjusted for age, sex, ethnicity, and socioeconomic deprivation, having a mild intellectual disability and being married were associated with increased odds of the intellectual disability being unrecorded in hospital records. We had no measure of quality of hospital care received and could not relate this to the presence or absence of a record of intellectual disability in the patient record. CONCLUSIONS Recognition and recording of intellectual disability in adults admitted to English general hospitals needs to be improved. Staff awareness training, screening at the point of admission, and data sharing between health and social care services could improve care for people with intellectual disability.
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Affiliation(s)
- Rory Sheehan
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Hassan Mansour
- Division of Psychiatry, University College London, London, United Kingdom
| | - Matthew Broadbent
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Andre Strydom
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, United Kingdom
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Zylbersztejn A, Stilwell PA, Zhu H, Ainsworth V, Allister J, Horridge K, Stephenson T, Wijlaars L, Gilbert R, Heys M, Hardelid P. Trends in hospital admissions during transition from paediatric to adult services for young people with learning disabilities or autism: Population-based cohort study. Lancet Reg Health Eur 2023; 24:100531. [PMID: 36394000 PMCID: PMC9649375 DOI: 10.1016/j.lanepe.2022.100531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022] Open
Abstract
Background Transition from paediatric to adult health care may disrupt continuity of care, and result in unmet health needs. We describe changes in planned and unplanned hospital admission rates before, during and after transition for young people with learning disability (LD), or autism spectrum disorders (ASD) indicated in hospital records, who are likely to have more complex health needs. Methods We developed two mutually exclusive cohorts of young people with LD, and with ASD without LD, born between 1990 and 2001 in England using national hospital admission data. We determined the annual rate of change in planned and unplanned hospital admission rates before (age 10–15 years), during (16–18 years) and after (19–24 years) transition to adult care using multilevel negative binomial regression models, accounting for area-level deprivation, sex, birth year and presence of comorbidities. Findings The cohorts included 51,291 young people with LD, and 46,270 autistic young people. Admission rates at ages 10–24 years old were higher for young people with LD (54 planned and 25 unplanned admissions per 100 person-years) than for autistic young people (17/100 and 16/100, respectively). For young people with LD, planned admission rates were highest and constant before transition (rate ratio [RR]: 0.99, 95% confidence interval [CI] 0.98–0.99), declined by 14% per year of age during (RR: 0.86, 95% CI: 0.85–0.88), and remained constant after transition (RR: 0.99, 95% CI: 0.99–1.00), mainly due to fewer admissions for non-surgical care, including respite care. Unplanned admission rates increased by 3% per year of age before (RR: 1.03, 95% CI: 1.02–1.03), remained constant during (RR: 1.01, 95% CI: 1.00–1.03) and increased by 3% per year after transition (RR: 1.03, 95% CI: 1.02–1.04). For autistic young people, planned admission rates increased before (RR: 1.06, 95% CI: 1.05–1.06), decreased during (RR: 0.95, 95% CI: 0.93–0.97), and increased after transition (RR: 1.05, 95%: 1.04–1.07). Unplanned admission rates increased most rapidly before (RR: 1.16, 95% CI: 1.15–1.17), remained constant during (RR: 1.01, 95% CI: 0.99–1.03), and increased moderately after transition (RR: 1.03, 95% CI: 1.02–1.04). Interpretation Decreases in planned admission rates during transition were paralleled by small but consistent increases in unplanned admission rates with age for young people with LD and autistic young people. Decreases in non-surgical planned care during transition could reflect disruptions to continuity of planned/respite care or a shift towards provision of healthcare in primary care and community settings and non-hospital arrangements for respite care. Funding National Institute for Health Research Policy Research Programme.
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Nicholson E, Doherty E, Guerin S, Schreiber J, Barrett M, McAuliffe E. Healthcare utilisation and unmet health needs in children with intellectual disability: a propensity score matching approach using longitudinal cohort data. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:442-453. [PMID: 35285998 PMCID: PMC9310956 DOI: 10.1111/jir.12927] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 01/25/2022] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Health disparities for children with intellectual disabilities can be challenging to measure due to many other factors that can impact health and healthcare use. The aim of the current study was to use longitudinal cohort data to compare children with intellectual disability (ID) in Ireland between 2006 and 2014 on healthcare utilisation and unmet need, at ages 9 and 13, using a propensity score matching (PSM) approach. METHODS Using data from the Growing up in Ireland study, PSM was used to identify an appropriate control sample to compare with a sample of children with ID (n = 124). Participants were matched on variables that are known to influence healthcare utilisation to reduce the impact of confounding variables between groups so that differences between the groups can be estimated. Logistic regression was used to estimate effects at ages 9 and 13. RESULTS Children with ID were no more likely to have visited a general practitioner or emergency department in the past 12 months than children without ID. They did have a greater likelihood of visiting a doctor in a hospital in the past 12 months and of having an overnight stay in hospital by age 9. Primary caregivers of children with ID were more likely to report unmet health needs at ages 9 and 13. CONCLUSIONS This approach is a novel means of comparing healthcare use in this population by balancing the impact of other factors that may result in inequities, to which children with ID may be more vulnerable.
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Affiliation(s)
- E. Nicholson
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS)UCD School of Nursing, Midwifery and Health Systems, UCD College of Health and Agricultural SciencesDublinIreland
- School of Psychology, Faculty of Science and HealthDublin City UniversityGlasnevin CampusDublin 9Ireland
| | - E. Doherty
- J.E. Cairnes School of Business & EconomicsNational University of Ireland GalwayGalwayIreland
| | - S. Guerin
- UCD Centre for Disability StudiesUCD School of Psychology, University College DublinDublinIreland
| | - J. Schreiber
- School of NursingDuquesne UniversityPittsburghPAUSA
| | - M. Barrett
- Children's Health Ireland (CHI) at CrumlinDublinIreland
- UCD School of MedicineUCD College of Health and Agricultural SciencesDublinIreland
| | - E. McAuliffe
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS)UCD School of Nursing, Midwifery and Health Systems, UCD College of Health and Agricultural SciencesDublinIreland
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Walker AR, Trollor JN, Florio T, Srasuebkul P. Predictors and outcomes of recognition of intellectual disability for adults during hospital admissions: A retrospective data linkage study in NSW, Australia. PLoS One 2022; 17:e0266051. [PMID: 35333913 PMCID: PMC8956190 DOI: 10.1371/journal.pone.0266051] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/11/2022] [Indexed: 11/18/2022] Open
Abstract
Adults with intellectual disability have high health care needs. Despite frequent contact with health services, they often receive inadequate health care. One method to improve health care delivery is reasonable adjustments, that is, the adaptation of health care delivery such that barriers to participation are removed for the person with disability. A starting point for the provision of reasonable adjustments is recognition of intellectual disability during the health care contact. To determine rates and predictors of the recognition of intellectual disability during hospital admissions, and its impact on admission metrics, we examined a population of adults with intellectual disability identified from disability services datasets from New South Wales, Australia between 2005 and 2014. Recognition of intellectual disability was determined by the recording of an International Classification of Diseases 10th revision (ICD-10) diagnostic code for intellectual disability during a given hospital admission. We examined how recognition of intellectual disability related to length of hospital episodes. We found an overall low rate of recognition of intellectual disability (23.79%) across all hospital episodes, with the proportion of hospital episodes recognising intellectual disability decreasing from 2005–2015. Admissions for adults with complex health profiles (e.g., those with many comorbidities, those with Autism Spectrum Disorder, and those admitted for urgent treatment) were more likely to recognise intellectual disability, but admissions for adults with complexity in other domains (i.e., for those in custody, or those with drug and alcohol disorders) were less likely to recognise intellectual disability. Recognition of intellectual disability was associated with longer episodes of care, possibly indicating the greater provision of reasonable adjustments. To improve the recognition of intellectual disability for adults during health service contacts, we advocate for the implementation of targeted initiatives (such as a nationwide disability flag to be included in health service records) to improve the provision of reasonable adjustments.
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Affiliation(s)
- Adrian Raymond Walker
- The Department of Developmental Disability Neuropsychiatry, The University of New South Wales Sydney, New South Wales, Australia
| | - Julian Norman Trollor
- The Department of Developmental Disability Neuropsychiatry, The University of New South Wales Sydney, New South Wales, Australia
- * E-mail:
| | - Tony Florio
- Australian Catholic University, New South Wales, Australia
| | - Preeyaporn Srasuebkul
- The Department of Developmental Disability Neuropsychiatry, The University of New South Wales Sydney, New South Wales, Australia
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Nicholson E, Conlon C, Mimmo L, Doherty E, Guerin S. Unscheduled healthcare for children with intellectual disabilities: A systematic scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:736-751. [PMID: 35322908 PMCID: PMC9314007 DOI: 10.1111/jar.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022]
Abstract
Background The provision of unscheduled healthcare for children with intellectual disability is less researched than that focused on hospital settings or for adult services. The aim of the scoping review was to map the evidence base in this area and identify areas for future study. Method A five‐stage scoping review framework was adopted. CINAHL, PubMed, SCOPUS, PsycINFO, Embase, ProQuest Dissertation & Theses and Google Scholar were searched. Studies published in English after 1/1/2000 were considered eligible for inclusion. Results A total of 3158 titles and abstracts were screened, 137 full‐text articles were reviewed, and 25 papers met the inclusion criteria. Descriptive themes focused on inequities, needs and experiences of families', poor GP training, and limitations of existing evidence. Conclusion Describing trends in healthcare utilisation by this population is valuable for monitoring quality of healthcare, however, addressing observed inequities will require approaches that recognise specific issues within the health system that result in inequities.
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Affiliation(s)
- Emma Nicholson
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.,School of Psychology, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - Ciara Conlon
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Laurel Mimmo
- School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Edel Doherty
- J.E. Cairnes School of Business & Economics, National University of Ireland Galway, Galway, Ireland
| | - Suzanne Guerin
- UCD Centre for Disability Studies, UCD School of Psychology, University College Dublin, Dublin, Ireland
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Mimmo L, Harrison R, Travaglia J, Hu N, Woolfenden S. Inequities in quality and safety outcomes for hospitalized children with intellectual disability. Dev Med Child Neurol 2022; 64:314-322. [PMID: 34562021 PMCID: PMC9293445 DOI: 10.1111/dmcn.15066] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 07/26/2021] [Accepted: 09/01/2021] [Indexed: 01/06/2023]
Abstract
AIM To investigate if there are inequities in quality and safety outcomes for children with intellectual disability admitted to two tertiary paediatric hospitals. METHOD A cross-sectional study of 1367 admissions for 1018 randomly selected patients admitted for more than 23 hours to one of two tertiary children's hospitals in Sydney, Australia (1st January-31st December 2017). Electronic medical records were manually interrogated to identify children with intellectual disability (including developmental delay). Data extracted included patient demographics, length of stay, number of admissions, and reported clinical incidents. RESULTS In total, 12.3% (n=125) of children admitted during the study period had intellectual disability, which represented 13.9% (n=190) of admissions. Sex and age at admission in children with and without intellectual disability were similar: 83 (43.7%) vs 507 (43.1%) females and 107 (56.3%) vs 670 (56.9%) males, p=0.875; median age 3 years (0-18y) vs 4 years (0-18y), p=0.122. Children with intellectual disability had significantly greater median length of stay (100.5h vs 79h, p<0.001) and cost of admission (A$11 596.38 vs A$8497.96) than their peers (p=0.001). Children with intellectual disability had more admissions with at least one incident compared to children without intellectual disability (14.7% vs 9.7%); this was not statistically significant (p=0.06). INTERPRETATION Children with intellectual disability experience inequitable quality and safety outcomes in hospital. Engaging children and families in clinical incident reporting may enhance understanding of safety risks for children with intellectual disability in hospital.
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Affiliation(s)
- Laurel Mimmo
- School of Population HealthFaculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia,Clinical Governance UnitThe Sydney Children’s Hospitals NetworkSydneyNew South WalesAustralia
| | - Reema Harrison
- Health Management ProgramsFaculty of MedicineSchool of Population HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Joanne Travaglia
- Faculty of HealthCentre for Health Services ManagementUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Nan Hu
- Faculty of MedicineSchool of Women’s and Children’s HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Susan Woolfenden
- Faculty of MedicineSchool of Women’s and Children’s HealthUniversity of New South WalesSydneyNew South WalesAustralia,Community Child HealthSydney Children’s Hospital, RandwickSydneyNew South WalesAustralia
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Brown HK, Saha S, Chan TCY, Cheung AM, Fralick M, Ghassemi M, Herridge M, Kwan J, Rawal S, Rosella L, Tang T, Weinerman A, Lunsky Y, Razak F, Verma AA. Outcomes in patients with and without disability admitted to hospital with COVID-19: a retrospective cohort study. CMAJ 2022; 194:E112-E121. [PMID: 35101870 PMCID: PMC8900770 DOI: 10.1503/cmaj.211277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Disability-related considerations have largely been absent from the COVID-19 response, despite evidence that people with disabilities are at elevated risk for acquiring COVID-19. We evaluated clinical outcomes in patients who were admitted to hospital with COVID-19 with a disability compared with patients without a disability. Methods: We conducted a retrospective cohort study that included adults with COVID-19 who were admitted to hospital and discharged between Jan. 1, 2020, and Nov. 30, 2020, at 7 hospitals in Ontario, Canada. We compared in-hospital death, admission to the intensive care unit (ICU), hospital length of stay and unplanned 30-day readmission among patients with and without a physical disability, hearing or vision impairment, traumatic brain injury, or intellectual or developmental disability, overall and stratified by age (≤ 64 and ≥ 65 yr) using multivariable regression, controlling for sex, residence in a long-term care facility and comorbidity. Results: Among 1279 admissions to hospital for COVID-19, 22.3% had a disability. We found that patients with a disability were more likely to die than those without a disability (28.1% v. 17.6%), had longer hospital stays (median 13.9 v. 7.8 d) and more readmissions (17.6% v. 7.9%), but had lower ICU admission rates (22.5% v. 28.3%). After adjustment, there were no statistically significant differences between those with and without disabilities for in-hospital death or admission to ICU. After adjustment, patients with a disability had longer hospital stays (rate ratio 1.36, 95% confidence interval [CI] 1.19–1.56) and greater risk of readmission (relative risk 1.77, 95% CI 1.14–2.75). In age-stratified analyses, we observed longer hospital stays among patients with a disability than in those without, in both younger and older subgroups; readmission risk was driven by younger patients with a disability. Interpretation: Patients with a disability who were admitted to hospital with COVID-19 had longer stays and elevated readmission risk than those without disabilities. Disability-related needs should be addressed to support these patients in hospital and after discharge.
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Affiliation(s)
- Hilary K Brown
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Sudipta Saha
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Timothy C Y Chan
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Angela M Cheung
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Michael Fralick
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Marzyeh Ghassemi
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Margaret Herridge
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Janice Kwan
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Shail Rawal
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Laura Rosella
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Terence Tang
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Adina Weinerman
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Yona Lunsky
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Fahad Razak
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Amol A Verma
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont.
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Mimmo L, Woolfenden S, Travaglia J, Strnadová I, Phillips MTAK, van Hoek MAD, Harrison R. Codesigning patient experience measures for and with children and young people with intellectual disability: a study protocol. BMJ Open 2021; 11:e050973. [PMID: 34872999 PMCID: PMC8650477 DOI: 10.1136/bmjopen-2021-050973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Children and young people with intellectual disability represent one of the most vulnerable groups in healthcare, yet they remain under-represented in projects to design, develop and/or improve healthcare service delivery. Increasingly, healthcare services are using various codesign and coproduction methodologies to engage children and young people in service delivery improvements. METHODS AND ANALYSIS This study employs an inclusive approach to the study design and execution, including two co-researchers who are young people with intellectual disability on the project team. We will follow an adapted experience-based co-design methodology to enable children and young people with intellectual disability to participate fully in the co-design of a prototype tool for eliciting patient experience data from children and young people with intellectual disability in hospital. ETHICS AND DISSEMINATION This study was granted ethical approval on 1 February 2021 by the Sydney Children's Hospitals Network Human Research Ethics Committee, reference number 2020/ETH02898. Dissemination plan includes publications, doctoral thesis chapter, educational videos. A summary of findings will be shared with all participants and presented at the organisation quality and safety committee.
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Affiliation(s)
- Laurel Mimmo
- Clinical Governance Unit, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
- Population Child Health, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- Population Child Health, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
| | - Joanne Travaglia
- Centre for Health Service Management, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Iva Strnadová
- Special Education and Disability Studies, School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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11
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Gill J, Morgan P, Enticott J. Emergency department usage by adults with cerebral palsy: A retrospective cohort study. Emerg Med Australas 2021; 34:169-175. [PMID: 34278708 DOI: 10.1111/1742-6723.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To retrospectively profile the ED usage for a cohort of adults with cerebral palsy (CP). METHODS Five years of ED data from a Victorian hospital network was analysed to identify participants with CP using the Victorian Emergency Minimum Dataset supplemented with scrutiny of inpatient admission data to identify cases because of limited ED coding of CP. Presentation frequency, emergency diagnoses (International Classification of Diseases, 10th Revision codes) and presentation sequelae were calculated and described. An investigation into rates of low urgency presentations was conducted. Differences between adult and paediatric cohorts were described. RESULTS Participants with CP constituted 1586 ED presentations. Adults represented 43% (n = 689) of these. Thirty percent of adults presented more than five times over the study period, with respiratory (25%), gastrointestinal (17%) and epilepsy/convulsion diagnoses (11%) being the most common presentations. Rates of inpatient hospital admissions from the ED increased with age in adults (P < 0.001). Low urgency presentations made up 8.9% of total adult presentations. CONCLUSIONS The high rates of respiratory diagnoses and epilepsy/convulsions, both ambulatory care-sensitive conditions, may be indicative of transitional challenges between paediatric and adult healthcare, potentially highlighting difficulties in accessing primary care services. Relatively low rates of 'low urgency' presentations may suggest perceived medical fragility in this vulnerable population. People with CP who present to ED and were not admitted may be underrepresented in this data. National expansion of this research will aid the development of an evidence-based model of care for CP in Australia.
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Affiliation(s)
- Jaskirath Gill
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Prue Morgan
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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12
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Azimi S, Lima F, Slack-Smith L, Bourke J, Calache H, Junaid M, Leonard H. Factors associated with dental hospitalisations in children with intellectual disability or autism spectrum disorder: a Western Australian population-based retrospective cohort study. Disabil Rehabil 2021; 44:5495-5503. [PMID: 34148478 DOI: 10.1080/09638288.2021.1936662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This study investigated dental hospitalisations in Western Australian (WA) children with intellectual disability (ID) and/or autism spectrum disorder (ASD) aged up to 18 years. METHODS Data on WA live births from 1983 to 2004 from the WA Midwives Notification System were linked to the Intellectual Disability Exploring Answers database, the WA Hospital Morbidity Data System, and the Western Australian Birth Defects Registry databases. Children were followed from birth to 2010 and the data grouped into three age-groups. Primary and secondary admissions for relevant dental diagnoses were identified and factors associated with having a dental hospitalisation investigated. RESULTS There were 1366, 1596, and 780 dental hospitalisations amongst 1122, 1154, and 609 children with ID and/or ASD in the 0-6, >6-12, and >12-18 year age groups, respectively. Children with severe ID were much more likely to be hospitalised than those with mild/moderate ID. More socioeconomically disadvantaged children were less likely to be hospitalised than children whose parents were socially advantaged. CONCLUSIONS There is concern that more vulnerable children in the WA community with ID or ASD are receiving an inadequate level of dental services compared with other groups resulting in potentially preventable hospitalisations, a situation in need of urgent remediation.Implications for rehabilitationLittle is known about why some children with intellectual disability (ID) or autism are being hospitalised for their dental care and others are not.Children with disability whose families are socioeconomically disadvantaged should have equivalent opportunity to receive optimal dental care.Dental practitioners at all levels need training and confidence in treating children with ID.
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Affiliation(s)
- Somayyeh Azimi
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,School of Human Sciences, University of Western Australia, Perth, Australia
| | - Fernando Lima
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Linda Slack-Smith
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Jenny Bourke
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Mohammed Junaid
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Perth, Australia
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13
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Lin E, Balogh R, Chung H, Dobranowski K, Durbin A, Volpe T, Lunsky Y. Looking across health and healthcare outcomes for people with intellectual and developmental disabilities and psychiatric disorders: population-based longitudinal study. Br J Psychiatry 2021; 218:51-57. [PMID: 33161927 DOI: 10.1192/bjp.2020.202] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Intellectual and developmental disabilities (IDDs) and psychiatric disorders frequently co-occur. Although each has been associated with negative outcomes, their combined effect has rarely been studied. AIMS To examine the likelihood of five negative health and healthcare outcomes for adults with IDD and mental health/addiction disorders (MHAs), both separately and together. For each outcome, demographic, clinical and system-level factors were also examined. METHOD Linked administrative data-sets were used to identify adults in Ontario, Canada, with IDD and MHA (n = 29 476), IDD-only (n = 35 223) and MHA-only (n = 727 591). Five outcomes (30-day readmission, 30-day repeat ED visit, delayed discharge, long-term care admission and premature mortality) were examined by logistic regression models with generalised estimating equation or survival analyses. For each outcome, crude (disorder groups only) and complete (adding biosocial covariates) models were run using a general population reference group. RESULTS The IDD and MHA group had the highest proportions across outcomes for both crude and complete models. They had the highest adjusted ratios for readmissions (aOR 1.93, 95%CI 1.88-1.99), repeat ED visit (aOR 2.00, 95%CI 1.98-2.02) and long-term care admission (aHR 12.19, 95%CI 10.84-13.71). For delayed discharge, the IDD and MHA and IDD-only groups had similar results (aOR 2.00 (95%CI 1.90-2.11) and 2.21 (95%CI 2.07-2.36). For premature mortality, the adjusted ratios were similar for all groups. CONCLUSIONS Poorer outcomes for adults with IDD, particularly those with MHA, suggest a need for a comprehensive, system-wide approach spanning health, disability and social support.
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Affiliation(s)
- Elizabeth Lin
- Office of Education, Centre for Addiction and Mental Health; ICES; and Department of Psychiatry, University of Toronto, Canada
| | - Robert Balogh
- ICES; and Faculty of Health Sciences, University of Ontario Institute of Technology, Canada
| | | | - Kristin Dobranowski
- Faculty of Health Sciences, University of Ontario Institute of Technology, Canada
| | - Anna Durbin
- ICES; Department of Psychiatry, University of Toronto; and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Canada
| | - Tiziana Volpe
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Canada
| | - Yona Lunsky
- ICES; Department of Psychiatry, University of Toronto; and Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Canada
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Mimmo L, Woolfenden S, Travaglia J, Harrison R. Creating equitable healthcare quality and safety for children with intellectual disability in hospital. Child Care Health Dev 2020; 46:644-649. [PMID: 32468634 PMCID: PMC7496444 DOI: 10.1111/cch.12787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/25/2020] [Accepted: 04/02/2020] [Indexed: 11/26/2022]
Abstract
Children with intellectual disability are susceptible to poor experiences of care and treatment outcomes, and this may compound existing health inequities. Evidence to date indicates three priority areas that must be addressed in order to reduce these inequities in the safety and quality of care for children with intellectual disability. Firstly, we need reliable methods to identify children with intellectual disability so that healthcare organizations understand their needs. Secondly, we need to develop quality metrics that can assess care quality and unwarranted care variation for children with intellectual disability in hospital. Finally, for a comprehensive understanding of the safety and quality of care for these children, and how to improve, it is critical that healthcare organizations partner with parents/carers and enable children with intellectual disability to voice their experiences of care. Children with intellectual disability have higher healthcare utilization than their peers; yet, their voice is rarely sought to optimize the safety and quality of their healthcare experience. Patient experience narratives enhance our understanding of the genesis of adverse events. By addressing these priorities, children with intellectual disability will be identified, and health services will measure and understand the problematic and beneficial variations in care delivery and can then effectively partner with children and their parents/carers to address the inequities in care quality and create safer healthcare.
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Affiliation(s)
- Laurel Mimmo
- Health Management, School of Public Health and Community Medicine, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia,Clinical Governance UnitSydney Children's Hospitals NetworkSydneyNew South WalesAustralia
| | - Susan Woolfenden
- School of Women’s and Children’s Health, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia,Community Child HealthSydney Children's HospitalRandwickNew South WalesAustralia
| | - Joanne Travaglia
- Health Services Management, Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Reema Harrison
- Health Management, School of Public Health and Community Medicine, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
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Nicholson E, Doherty E, Somanadhan S, Guerin S, Schreiber J, Bury G, Kroll T, Raley M, McAuliffe E. Health inequities in unscheduled healthcare for children with intellectual disabilities in Ireland: a study protocol. HRB Open Res 2020; 3:3. [PMID: 32832849 PMCID: PMC7431971 DOI: 10.12688/hrbopenres.12973.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Health inequities for children with intellectual disabilities are prevalent within different health systems, and children with intellectual disabilites have shorter life expectancies than the general population, higher mortality rates before the age of 17 and have a greater risk of potentially preventable hospitalisations. A health systems approach to research in this area provides a useful means through which research can inform policy and practice to ensure people with intellectual disabilities receive equitable healthcare; however, there is a paucity of evidence regarding how to address differences that have been described in the literature to date. The overall aim of this research is to establish the extent of health inequities for children with intellectual disabilities in Ireland compared to children without intellectual disabilities with respect to their utilisation of primary care and rates of hospitalisation, and to gain a better understanding of what influences utilisation of primary care and emergency department services in this population. Methods and analysis: The design of this research adopts a multi-methods approach: statistical analysis of health data to determine the extent of health inequities in relation to healthcare utilisation; discrete choice experiments to explore General Practitioners' decision making and parental preferences for optimal care; and concept mapping to develop consensus between stakeholders on how to address current healthcare inequities. Discussion: By applying a systems lens to the issue of health inequities for children with intellectual disabilities, the research hopes to gain a thorough understanding of the varying components that can contribute to the maintenance of such healthcare inequities. A key output from the research will be a set of feasible solutions and interventions that can address health inequities for this population.
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Affiliation(s)
- Emma Nicholson
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), University College Dublin, Belfield, Dublin 4, Ireland
| | - Edel Doherty
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, University Road, Galway, Ireland
| | - Suja Somanadhan
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Suzanne Guerin
- UCD Centre for Disability Studies, University College Dublin, Belfield, Dublin 4, Ireland
| | | | - Gerard Bury
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Thilo Kroll
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), University College Dublin, Belfield, Dublin 4, Ireland
| | - Meredith Raley
- Disability Federation of Ireland, Fumbally Court, Dublin 8, Ireland
| | - Eilish McAuliffe
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), University College Dublin, Belfield, Dublin 4, Ireland
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Doidge JC, Morris JK, Harron KL, Stevens S, Gilbert R. Prevalence of Down's Syndrome in England, 1998-2013: Comparison of linked surveillance data and electronic health records. Int J Popul Data Sci 2020; 5:1157. [PMID: 32864476 PMCID: PMC7115985 DOI: 10.23889/ijpds.v5i1.1157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Disease registers and electronic health records are valuable resources for disease surveillance and research but can be limited by variation in data quality over time. Quality may be limited in terms of the accuracy of clinical information, of the internal linkage that supports person-based analysis of most administrative datasets, or by errors in linkage between multiple datasets. OBJECTIVES By linking the National Down Syndrome Cytogenetic Register (NDSCR) to Hospital Episode Statistics for England (HES), we aimed to assess the quality of each and establish a consistent approach for analysis of trends in prevalence of Down's syndrome among live births in England. METHODS Probabilistic record linkage of NDSCR to HES for the period 1998-2013 was supported by linkage of babies to mothers within HES. Comparison of prevalence estimates in England were made using NDSCR only, HES data only, and linked data. Capture-recapture analysis and quantitative bias analysis were used to account for potential errors, including false positive diagnostic codes, unrecorded diagnoses, and linkage error. RESULTS Analyses of single-source data indicated increasing live birth prevalence of Down's Syndrome, particularly in the analysis of HES. Linked data indicated a contrastingly stable prevalence of 12.3 (plausible range: 11.6-12.7) cases per 10 000 live births. CONCLUSION Case ascertainment in NDSCR improved slightly over time, creating a picture of slowly increasing prevalence. The emerging epidemic suggested by HES primarily reflects improving linkage within HES (assignment of unique patient identifiers to hospital episodes). Administrative data are valuable but trends should be interpreted with caution, and with assessment of data quality over time. Data linkage with quantitative bias analysis can provide more robust estimation and, in this case, stronger evidence that prevalence is not increasing. Routine linkage of administrative and register data can enhance the value of each.
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Affiliation(s)
- JC Doidge
- UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
- Intensive Care National Audit and Research Centre, London, WC1V 6AZ, UK
| | - JK Morris
- Population Health Research Institute, St George's University of London, London, SW17 0RE, UK
| | - KL Harron
- UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - S Stevens
- Public Health England, London, SE1 6LH, UK
| | - R Gilbert
- UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
- Health Data Research UK, University College London, London, NW1 2DA, UK
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Fairthorne J, Bourke J, O'Donnell M, Wong K, de Klerk N, Llewellyn G, Leonard H. Pregnancy and birth outcomes of mothers with intellectual disability and their infants: Advocacy needed to improve well-being. Disabil Health J 2019; 13:100871. [PMID: 31806497 DOI: 10.1016/j.dhjo.2019.100871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pregnancy in women with intellectual disability (ID) is increasingly recognised, along with their increased likelihood of experiencing risk factors for adverse pregnancy and infant outcomes. OBJECTIVES We aimed to compare risks of socio-demographic, pregnancy and infant outcomes of women with ID to other women. METHODS All mothers with children born in Western Australia from 1983 to 2012 were linked to the population-based Intellectual Disability Exploring Answers database. Mothers with ID were matched by age and Aboriginality to a population sample of mothers without ID. Pregnancy and birth outcomes were compared for both groups and logistic regression was used to compare outcome risks. RESULTS Compared to non-Aboriginal mothers without ID, non-Aboriginal mothers with ID were more likely to be of low socio-economic status, be without partner, smoke antenatally and have pre-existing asthma. They had a 1.5 times increased risk of pregnancy complications, specifically pre-eclampsia, urinary tract infection, threatened preterm labour and post-partum haemorrhage. After adjustment for maternal medical conditions and pregnancy complications, infants of Aboriginal mothers with ID had twice the risk of preterm birth and 1.6 times the risk of having percentage of optimal head circumference <95% compared to infants of Aboriginal mothers without ID. Infants of both Aboriginal and non-Aboriginal mothers with ID were more likely to have percentage of optimal birth weight <85% compared to those without ID. CONCLUSIONS For mothers with ID, modifiable risk factors for adverse outcomes need addressing. They may require additional assistance during pregnancy, including more frequent consultations and support to assist with pregnancy management.
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Affiliation(s)
- Jenny Fairthorne
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Jenny Bourke
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Melissa O'Donnell
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Nick de Klerk
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | | | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
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Strobel NA, Bourke J, Leonard H, Richardson A, Edmond KM, McAullay D. Assessing the quality, efficiency and usefulness of the Western Australian population-based Intellectual Disability Exploring Answers (IDEA) surveillance system: a surveillance system evaluation. BMJ Open 2019; 9:e026003. [PMID: 31630096 PMCID: PMC6803127 DOI: 10.1136/bmjopen-2018-026003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Our overall aim was to evaluate the Western Australian Intellectual Disability Exploring Answers (IDEA) surveillance system. The primary objective was to evaluate the attributes of the system. The secondary objective was to provide recommendations to data custodians and stakeholders to strengthen the system. METHOD The IDEA system was evaluated using process observation, interviews and secondary data analysis of system attributes: usefulness, simplicity, data quality, acceptability, representativeness, timeliness and stability. 2001 US Centers for Disease Control and Prevention guidelines were used. RESULTS We found that the IDEA system was useful, simple, flexible, acceptable, representative, timely and stable. We compared individuals from the IDEA system (n=10 593) with those with cerebral palsy and intellectual disability (ID) (n=582) from another surveillance system. Of the 582 with cerebral palsy and ID, 501 (86.1%) were in the IDEA system and 81 (13.9%) were not. In total, 0.7% of cases (81/10674) with ID were not identified in the IDEA system. There were little differences in cases that were not identified in the IDEA system between Indigenous status, sex and place of residence. CONCLUSIONS The strengths of the IDEA system include having a high data quality resource contributing to national and international data on ID, strong government support and a dedicated management team. Output from studies linking to IDEA data have had major contributions to the international literature about ID. However, limited resources have prevented it from realising its full potential in relation to translational activities. The IDEA system is a valuable resource to address the needs of people living with ID.
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Affiliation(s)
- Natalie A Strobel
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
- NCEPH, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jenny Bourke
- Telethon Kids Institute, West Perth, Western Australia, Australia
| | - Helen Leonard
- Telethon Kids Institute, West Perth, Western Australia, Australia
| | - Alice Richardson
- NCEPH, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen M Edmond
- Department Of Women & Children's Health, King's College London, London, UK
| | - Daniel McAullay
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
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Balogh R, Leonard H, Bourke J, Brameld K, Downs J, Hansen M, Glasson E, Lin E, Lloyd M, Lunsky Y, O'Donnell M, Shooshtari S, Wong K, Krahn G. Data Linkage: Canadian and Australian Perspectives on a Valuable Methodology for Intellectual and Developmental Disability Research. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:439-462. [PMID: 31568733 DOI: 10.1352/1934-9556-57.5.439] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Data linkage holds great promise for generating new information about people with intellectual and developmental disabilities (IDD) as a population, yet few centers have developed the infrastructure to utilize this methodology. Two examples, from Canada and Australia, describe their efforts in building data linkage capabilities, and how linked databases can be used to identify persons with IDD and used for population-based research. The value of data linkage is illustrated through new estimates of prevalence of IDD; health service utilization patterns; associations with sociodemographic characteristics, and with physical and mental health conditions (e.g., chronic diseases, injury, fertility, and depression); and findings on equity in medical treatments. Examples are provided of findings used for governmental policy and program planning.
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Affiliation(s)
- Robert Balogh
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Helen Leonard
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Jenny Bourke
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Kate Brameld
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Jenny Downs
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Michele Hansen
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Emma Glasson
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Elizabeth Lin
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Meghann Lloyd
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Yona Lunsky
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Melissa O'Donnell
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Shahin Shooshtari
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Kingsley Wong
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Gloria Krahn
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
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Hansen M, Greenop KR, Bourke J, Baynam G, Hart RJ, Leonard H. Intellectual Disability in Children Conceived Using Assisted Reproductive Technology. Pediatrics 2018; 142:peds.2018-1269. [PMID: 30442875 DOI: 10.1542/peds.2018-1269] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine whether children conceived using assisted reproductive technology (ART) have a higher risk of intellectual disability (ID) compared with non-ART-conceived children and describe known causes of ID in these groups. METHODS We linked ID and ART data from population-based registers in Western Australia. Our cohort included live births from 1994 to 2002 (n = 210 627) with at least 8 years of follow-up. The prevalence of ID was compared between ART- and non-ART-conceived children, and risk of ID was estimated using Poisson regression with robust SEs. We also stratified by plurality and gestation at delivery. RESULTS Children conceived using ART had a small increased risk of ID (risk ratio 1.58; 95% confidence interval 1.19-2.11) even when analyses were restricted to singleton births (risk ratio 1.56; 95% confidence interval 1.10-2.21). The risk of ID was more than doubled for those born very preterm, for severe ID, and after intracytoplasmic sperm injection (ICSI) treatments. Children conceived using ICSI had a greater risk of ID than those conceived using in vitro fertilization and were more likely to have a known genetic cause for ID (27.6% vs 12.9% in vitro fertilization and 11.9% non-ART). CONCLUSIONS The risk of ID was increased in children born after ART in Western Australia from 1994 to 2002. More recent cohorts should be examined to assess the impact of important changes in ART clinical practice. Our results are particularly pertinent because multiple embryo transfers are routinely performed in many countries, increasing the risk of preterm birth, and ICSI use rates are high.
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Affiliation(s)
| | | | | | - Gareth Baynam
- Telethon Kids Institute and.,Divisions of Paediatrics and.,Genetic Services of Western Australia and.,Western Australia Register of Developmental Anomalies.,King Edward Memorial Hospital, Perth, Australia; and
| | - Roger J Hart
- King Edward Memorial Hospital, Perth, Australia; and.,Obstetrics and Gynaecology, University of Western Australia, Perth, Australia.,Fertility Specialists of Western Australia, Perth, Australia
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Brameld K, Spilsbury K, Rosenwax L, Leonard H, Semmens J. Use of health services in the last year of life and cause of death in people with intellectual disability: a retrospective matched cohort study. BMJ Open 2018; 8:e020268. [PMID: 29478966 PMCID: PMC5855242 DOI: 10.1136/bmjopen-2017-020268] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/12/2017] [Accepted: 01/22/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the cause of death together with emergency department presentations and hospital admissions in the last year of life of people with intellectual disability. METHOD A retrospective matched cohort study using de-identified linked data of people aged 20 years or over, with and without intellectual disability who died during 2009 to 2013 in Western Australia. Emergency department presentations and hospital admissions in the last year of life of people with intellectual disability are described along with cause of death. RESULTS Of the 63 508 deaths in Western Australia from 2009 to 2013, there were 591 (0.93%) decedents with a history of intellectual disability. Decedents with intellectual disability tended to be younger, lived in areas of more social disadvantage, did not have a partner and were Australian born compared with all other decedents. A matched comparison cohort of decedents without intellectual disability (n=29 713) was identified from the general population to improve covariate balance.Decedents with intellectual disability attended emergency departments more frequently than the matched cohort (mean visits 3.2 vs 2.5) and on average were admitted to hospital less frequently (mean admissions 4.1 vs 6.1), but once admitted stayed longer (average length of stay 5.2 days vs 4.3 days). People with intellectual disability had increased odds of presentation, admission or death from conditions that have been defined as ambulatory care sensitive and are potentially preventable. These included vaccine-preventable respiratory disease, asthma, cellulitis and convulsions and epilepsy. CONCLUSION People with intellectual disability were more likely to experience potentially preventable conditions at the end of their lives. This indicates a need for further improvements in access, quality and coordination of healthcare to provide optimal health for this group.
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Affiliation(s)
- Kate Brameld
- Curtin-Monash Accident Research Centre, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Katrina Spilsbury
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Lorna Rosenwax
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Helen Leonard
- Telethon Kids Institute, Subiaco, Western Australia, Australia
| | - James Semmens
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- The Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
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