Journal of Intellectual Disability Research

Volume 68, Issue 6 pp. 573-584

Original Article

Hospitalisation and mortality among privately insured individuals with COVID-19 in the United States: The role of intellectual disabilities and Neurogenetic disorders

A. Davis,

A. Davis

orcid.org/0000-0002-5448-9775

Disability Health Research Center, Johns Hopkins University School of Nursing, Baltimore, MD, USA

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N. Copeland-Linder,

N. Copeland-Linder

Psychology Department, Notre Dame of Maryland University, Baltimore, MD, USA

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K. Phuong,

K. Phuong

Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA

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H. Belcher,

H. Belcher

Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, MD, USA

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K. van Eck,

Corresponding Author

K. van Eck

[email protected]

Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, MD, USA

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Correspondence: Dr Kathryn Van Eck, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD 21205, USA (e-mail: [email protected]).Search for more papers by this author

A. Davis,

A. Davis

orcid.org/0000-0002-5448-9775

Disability Health Research Center, Johns Hopkins University School of Nursing, Baltimore, MD, USA

Search for more papers by this author

N. Copeland-Linder,

N. Copeland-Linder

Psychology Department, Notre Dame of Maryland University, Baltimore, MD, USA

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K. Phuong,

K. Phuong

Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA

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H. Belcher,

H. Belcher

Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, MD, USA

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K. van Eck,

Corresponding Author

K. van Eck

[email protected]

Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, MD, USA

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Correspondence: Dr Kathryn Van Eck, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD 21205, USA (e-mail: [email protected]).Search for more papers by this author

First published: 19 February 2024

https://doi.org/10.1111/jir.13116

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Abstract

Background

Individuals with intellectual disabilities (IDs) and neurogenetic conditions (IDNDs) are at greater risk for comorbidities that may increase adverse outcomes for this population when they have coronavirus disease 2019 (COVID-19). The study aims are to examine the population-level odds of hospitalisation and mortality of privately insured individuals with COVID-19 with and without IDNDs IDs, controlling for sociodemographics and comorbid health conditions.

Methods

This is a retrospective, cross-sectional study of 1174 individuals with IDs and neurogenetic conditions within a population of 752 237 de-identified, privately insured, US patients diagnosed with COVID-19 between February 2020 and September 2020. Odds of hospitalisation and mortality among COVID-19 patients with IDNDs adjusted for demographic characteristics, Health Resources and Services Administration region, states with Affordable Care Act and number of comorbid health conditions were analysed.

Results

Patients with IDNDs overall had higher rates of COVID-19 hospitalisation than those without IDNDs (35.01% vs. 12.65%, P < .0001) and had higher rates of COVID-19 mortality than those without IDNDs (4.94% vs. .88%, P < .0001). Adjusting for sociodemographic factors only, the odds of being hospitalised for COVID-19 associated with IDNDs was 4.05 [95% confidence interval (CI) 3.56–4.61]. Adjusting for sociodemographic factors and comorbidity count, the odds of hospitalisation for COVID-19 associated with IDNDs was 1.42 (95% CI 1.25–1.61). The odds of mortality from COVID-19 for individuals with IDNDs adjusted for sociodemographic factors only was 4.65 (95% CI 3.47–6.24). The odds of mortality from COVID-19 for patients with IDNDs adjusted for sociodemographic factors and comorbidity count was 2.70 (95% CI 2.03–3.60). A major finding of the study was that even when considering the different demographic structure and generally higher disease burden of patients with IDNDs, having a IDND was an independent risk factor for increased hospitalisation and mortality compared with patients without IDNDs.

Conclusions

Individuals with IDNDs had significantly higher odds of hospitalisation and mortality after adjusting for sociodemographics. Results remained significant with a slight attenuation after adjusting for sociodemographics and comorbidities. Adjustments for comorbidity count demonstrated a dose–response increase in odds of both hospitalisation and mortality, illustrating the cumulative effect of health concerns on COVID-19 outcomes. Together, findings highlight that individuals with IDNDs experience vulnerability for negative COVID-19 health outcomes with implications for access to comprehensive healthcare.

Conflict of Interest

No conflicts of interest have been declared.

Open Research

Data Availability Statement

The data that produced the findings from this study are available from FAIR Health. Restrictions apply to the availability of these data, given that they were used under license for this study. Please contact FAIR Health regarding access to these data.

Supporting Information

References

Anderson L. L., Humphries K., McDermott S., Marks B., Sisirak J. & Larson S. (2013) The state of the science of health and wellness for adults with intellectual and developmental disabilities. Intellectual and Developmental Disabilities 51, 385–398.
10.1352/1934-9556-51.5.385
PubMed Web of Science® Google Scholar
APA. (2021) What is intellectual disability? American Psychiatric Association. Available at: https://www.psychiatry.org/patients-families/intellectual-disability/what-is-intellectual-disability
Google Scholar
Baksh R. A., Pape S. E., Smith J. & Strydom A. (2021) Understanding inequalities in COVID-19 outcomes following hospital admission for people with intellectual disability compared to the general population: a matched cohort study in the U.K. BMJ Open 11, e052482.
10.1136/bmjopen-2021-052482
PubMed Web of Science® Google Scholar
Buonaguro E. F. & Bertelli M. O. (2021) COVID-19 and intellectual disability/autism spectrum disorder with high and very high support needs: issues of physical and mental vulnerability. Advances in Mental Health and Intellectual Disabilities 15, 8–19.
10.1108/AMHID-07-2020-0016
Web of Science® Google Scholar
Burke E., O'Dwyer M., Maes-Festen D. & Oppewal A. (2023) Chronic health among those with an intellectual disability. In: Intellectual Disabilities: Health and Social Care Across the Lifespan, pp. 121–146. Springer International Publishing, Cham.
10.1007/978-3-031-27496-1_9
Google Scholar
Clift A. K., Coupland C. A., Keogh R. H., Hemingway H. & Hippisley-Cox J. (2021) COVID-19 mortality risk in Down syndrome: results from a cohort study of 8 million adults. Annals of Internal Medicine 174, 572–576.
10.7326/M20-4986
PubMed Web of Science® Google Scholar
CMS (2022) Chronic conditions. Chronic Conditions Data Warehouse. Retrieved from Available at: https://www2.ccwdata.org/web/guest/condition-categories
Google Scholar
Courtemanche C., Marton J., Ukert B., Yelowitz A., Zapata D. & Fazlul I. (2019) The three-year impact of the Affordable Care Act on disparities in insurance coverage. Health Services Research 54, 307–316.
10.1111/1475-6773.13077
PubMed Web of Science® Google Scholar
Dahlgren G. & Whitehead M. (2021) The Dahlgren–Whitehead model of health determinants: 30 years on and still chasing rainbows. Public Health 199, 20–24.
10.1016/j.puhe.2021.08.009
PubMed Web of Science® Google Scholar
Das-Munshi J., Chang C. K., Bakolis I., Broadbent M., Dregan A., Hotopf M. et al. (2021) All-cause and cause-specific mortality in people with mental disorders and intellectual disabilities, before and during the COVID-19 pandemic: cohort study. The Lancet Regional Health-Europe 11, 100228.
10.1016/j.lanepe.2021.100228
Google Scholar
Dong X., Gindling T. H. & Miller N. A. (2022) Effects of the Medicaid expansion under the Affordable Care Act on health insurance coverage, health care access, and use for people with disabilities. Disability and Health Journal 15, 101180.
10.1016/j.dhjo.2021.101180
PubMed Web of Science® Google Scholar
Doody O. & Keenan P. M. (2021) The reported effects of the COVID-19 pandemic on people with intellectual disability and their careers: a scoping review. Annals of Medicine 53, 786–804.
10.1080/07853890.2021.1922743
CAS PubMed Web of Science® Google Scholar
Elmore R., Schmidt L., Lam J., Howard B. E., Tandon A., Norman C. et al. (2020) Risk and protective factors in the COVID-19 pandemic: a rapid evidence map. Frontiers in Public Health 8, 582205.
10.3389/fpubh.2020.582205
PubMed Web of Science® Google Scholar
Embregts P. J. C. M., Heerkens L., Frielink N., Giesbers S., Vromans L. & Jahoda A. (2021) Experiences of mothers caring for a child with an intellectual disability during the COVID-19 pandemic in the Netherlands. Journal of Intellectual Disability Research 65, 760–771.
10.1111/jir.12859
CAS PubMed Web of Science® Google Scholar
Ervin D. A., Hennen B., Merrick J. & Morad M. (2014) Healthcare for persons with intellectual and developmental disability in the community. Frontiers in Public Health 2, 83.
PubMed Google Scholar
FAIRHealth (2023) Overview. Retrieved from Who We Serve – Research|FAIR Health.
Google Scholar
Friedman C. (2020) Quality of life outcome and support disparities among people with more severe impairments. Intellectual and Developmental Disabilities 58, 513–524.
10.1352/1934-9556-58.6.513
PubMed Web of Science® Google Scholar
Frankova H. (2020) The impact of COVID-19 on people with autism, learning disabilities and mental health conditions. Nursing and Residential Care 22, 1–3.
10.12968/nrec.2020.22.6.10
Google Scholar
Fujiura G. T., Li H. & Magaña S. (2018) Health services use and costs for Americans with intellectual and developmental disabilities: a national analysis. Intellectual Developmental Disabilities 56, 101–118.
10.1352/1934-9556-56.2.101
PubMed Web of Science® Google Scholar
Gleason J., Ross W., Fossi A., Blonsky H., Tobias J. & Stephens M. (2021) The devastating impact of Covid-19 on individuals with intellectual disabilities in the United States. NEJM Catalyst Innovations in Care Delivery 2.
PubMed Google Scholar
Heller T. & Sorensen A. (2013) Promoting healthy aging in adults with developmental disabilities. Developmental Disabilities Research Reviews 18, 22–30.
10.1002/ddrr.1125
CAS PubMed Web of Science® Google Scholar
Henderson A., Fleming M., Cooper S. A., Pell J. P., Melville C., Mackay D. F. et al. (2022) COVID-19 infection and outcomes in a population-based cohort of 17 203 adults with intellectual disabilities compared with the general population. Journal of Epidemiology and Community Health 76, 550–555.
10.1136/jech-2021-218192
PubMed Web of Science® Google Scholar
Health Resources & Services Administration (HRSA) (2021) HRSA Office of Intergovernmental and External Affairs. Retrieved from Available at: https://www.hrsa.gov/about/organization/offices/hrsa-iea
Google Scholar
Jeste S., Hyde C., Distefano C., Halladay A., Ray S., Porath M. et al. (2020) Changes in access to educational and healthcare services for individuals with intellectual and developmental disabilities during COVID-19 restrictions. Journal of Intellectual Disability Research 64, 825–833.
10.1111/jir.12776
CAS PubMed Web of Science® Google Scholar
Karmakar M., Lantz P. M. & Tipirneni R. (2021) Association of social and demographic factors with COVID-19 incidence and death rates in the U.S. JAMA Network Open 4, e2036462.
10.1001/jamanetworkopen.2020.36462
PubMed Web of Science® Google Scholar
Karpur A., Vasudevan V., Shih A. & Frazier T. (2022) Brief report: impact of COVID-19 in individuals with autism spectrum disorders: analysis of a national private claims insurance database. Journal of Autism and Developmental Disorders 52, 2350–2356.
10.1007/s10803-021-05100-x
PubMed Web of Science® Google Scholar
Keisler-Starkey, K., & Bunch, L. N. (2021) Health insurance coverage in the United States: 2020. U.S. Census Bureau Current Population Reports, P60-274. Retrieved from Available at: https://www.census.gov/library/publications/2021/demo/p60-274.html
Google Scholar
Khan M. M. A., Khan M. N., Mustagir M. G., Rana J., Islam M. S. & Kabir M. I. (2020) Effects of underlying morbidities on the occurrence of deaths in COVID-19 patients: a systematic review and meta-analysis. Journal of Global Health 10, 020503.
10.7189/jogh.10.020503
PubMed Web of Science® Google Scholar
Koyama A. K., Koumans E. H., Sircar K., Lavery A., Hsu J., Ryerson A. B. et al. (2022) Severe outcomes, readmission, and length of stay among COVID-19 patients with intellectual and developmental disabilities. International Journal of Infectious Diseases 116, 328–330.
10.1016/j.ijid.2022.01.038
CAS PubMed Web of Science® Google Scholar
Landes S. D., Stevens J. D. & Turk M. A. (2019) Heterogeneity in age at death for adults with developmental disability. Journal of Intellectual Disability Research 63, 1482–1487.
10.1111/jir.12672
CAS PubMed Web of Science® Google Scholar
Landes S. D., Turk M. A., Formica M. K., McDonald K. E. & Stevens J. D. (2020) COVID-19 outcomes among people with intellectual and developmental disability living in residential group homes in New York state. Disability and Health Journal 13, 100969.
10.1016/j.dhjo.2020.100969
PubMed Web of Science® Google Scholar
Landes S. D., Stevens J. D. & Turk M. A. (2021a) Cause of death in adults with intellectual disability in the United States. Journal of Intellectual Disability Research 65, 47–59.
10.1111/jir.12790
CAS PubMed Web of Science® Google Scholar
Landes S. D., Turk M. A. & Wong A. W. (2021b) COVID-19 outcomes among people with intellectual and developmental disability in California: the importance of type of residence and skilled nursing care needs. Disability and Health Journal 14, 101051.
10.1016/j.dhjo.2020.101051
PubMed Web of Science® Google Scholar
Landes S. D., Turk M. A., Damiani M. R., Proctor P. & Baier S. (2021c) Risk factors associated with COVID-19 outcomes among people with intellectual and developmental disabilities receiving residential services. JAMA Network Open 4, e2112862.
10.1001/jamanetworkopen.2021.12862
PubMed Web of Science® Google Scholar
Landon S. N., Padikkala J. & Horwitz L. I. (2022) Identifying drivers of health care value: a scoping review of the literature. BMC Health Services Research 22, 845.
10.1186/s12913-022-08225-6
PubMed Web of Science® Google Scholar
Lunsky Y., Durbin A., Balogh R., Lin E., Palma L. & Plumptre L. (2022) COVID-19 positivity rates, hospitalizations and mortality of adults with and without intellectual and developmental disabilities in Ontario, Canada. Disability and Health Journal 15, 101174.
10.1016/j.dhjo.2021.101174
PubMed Web of Science® Google Scholar
McMaughan D. J., Oloruntoba O. & Smith M. L. (2020) Socioeconomic status and access to healthcare: interrelated drivers for healthy aging. Frontiers in Public Health 8, 231.
10.3389/fpubh.2020.00231
PubMed Web of Science® Google Scholar
Moran C., Oliver N., Szabo B., Collins L., Nguyen M., Shah S. et al. (2021) Comorbidity burden is associated with hospitalization for COVID-19 among PWH. Topics in Antiviral Medicine 29, 207.
Google Scholar
O'Leary L., Cooper S. A. & Hughes-McCormack, L. (2018) Early death and causes of death of people with intellectual disabilities: a systematic review. Journal of Applied Research in Intellectual Disabilities 31, 325–342.
10.1111/jar.12417
PubMed Web of Science® Google Scholar
Perera B., Laugharne R., Henley W., Zabel A., Lamb K., Branford D. et al. (2020) COVID-19 deaths in people with intellectual disability in the U.K. and Ireland: descriptive study. BJPsych open 6, e123.
10.1192/bjo.2020.102
PubMed Google Scholar
Potvin L. A., Fulford C., Ouellette-Kuntz H. & Cobigo V. (2019) What adults with intellectual and developmental disabilities say they need to access annual health examinations: system navigation support and person-centred care. Canadian Family Physician 65, S47–S52.
PubMed Web of Science® Google Scholar
Rawlings G. H. & Beail N. (2022) Long-COVID in people with intellectual disabilities: a call for research of a neglected area. British Journal of Learning Disabilities 51, 91–98.
10.1111/bld.12499
Web of Science® Google Scholar
Rollston R. & Galea S. (2020) COVID-19 and the social determinants of health. American Journal of Health Promotion 34, 687–689.
10.1177/0890117120930536b
PubMed Web of Science® Google Scholar
Scheffers F., van Vugt E. & Moonen X. (2020) Resilience in the face of adversity in adults with an intellectual disability: a literature review. Journal of Applied Research in Intellectual Disabilities 33, 828–838.
10.1111/jar.12720
PubMed Web of Science® Google Scholar
Schott W., Tao S. & Shea L. (2022) COVID-19 risk: adult Medicaid beneficiaries with autism, intellectual disability, and mental health conditions. Autism 26, 975–987.
10.1177/13623613211039662
PubMed Web of Science® Google Scholar
Sommers B. D. (2020) Health insurance coverage: what comes after the ACA? An examination of the major gaps in health insurance coverage and access to care that remain ten years after the Affordable Care Act. Health Affairs 39, 502–508.
10.1377/hlthaff.2019.01416
Web of Science® Google Scholar
Taggart L., Mulhall P., Kelly R., Trip H., Sullivan B. & Wallén E. F. (2022) Preventing, mitigating, and managing future pandemics for people with an intellectual and developmental disability – learnings from COVID-19: a scoping review. Journal of Policy and Practice in Intellectual Disabilities 19, 4–34.
10.1111/jppi.12408
Web of Science® Google Scholar
Tromans S., Kinney M., Chester V., Alexander R., Roy A., Sander J. W. et al. (2020) Priority concerns for people with intellectual and developmental disabilities during the COVID-19 pandemic. BJPsych Open 6, e128.
10.1192/bjo.2020.122
PubMed Web of Science® Google Scholar
Turk M. A., Landes S. D., Formica M. K. & Goss K. D. (2020) Intellectual and developmental disability and COVID-19 case-fatality trends: TriNetX analysis. Disability and Health Journal 13, 100942.
10.1016/j.dhjo.2020.100942
PubMed Web of Science® Google Scholar
Vereijken F. R., Giesbers S. A., Jahoda A. & Embregts P. J. (2022) Homeward bound: Exploring the motives of mothers who brought their offspring with intellectual disabilities home from residential settings during the COVID-19 pandemic. Journal of Applied Research in Intellectual Disabilities 35, 150–159.
10.1111/jar.12930
PubMed Web of Science® Google Scholar
Vohra R., Madhavan S. & Sambamoorthi U. (2017) Comorbidity prevalence, healthcare utilization, and expenditures of Medicaid enrolled adults with autism spectrum disorders. Autism 21, 995–1009.
10.1177/1362361316665222
PubMed Web of Science® Google Scholar
Williamson E. J., McDonald H. I., Bhaskaran K., Walker A. J., Bacon S., Davy S. et al. (2021) Risks of covid-19 hospital admission and death for people with learning disability: population based cohort study using the OpenSAFELY platform. British Medical Journal 374, n1592.
10.1136/bmj.n1592
PubMed Google Scholar
Zablotsky, B. & Alford, J. M. (2020) Racial and ethnic differences in the prevalence of attention-deficit/hyperactivity disorder and learning disabilities among U.S. children aged 3'17 years. NCHS Data Brief. No. 358. National Center for Health Statistics.
Google Scholar

Volume68, Issue6

June 2024

Pages 573-584

Hospitalisation and mortality among privately insured individuals with COVID-19 in the United States: The role of intellectual disabilities and Neurogenetic disorders

Abstract

Background

Methods

Results

Conclusions

Conflict of Interest

Open Research

Data Availability Statement

Supporting Information

References

References

Information

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Hospitalisation and mortality among privately insured individuals with COVID-19 in the United States: The role of intellectual disabilities and Neurogenetic disorders

Abstract

Background

Methods

Results

Conclusions

Conflict of Interest

Open Research

Data Availability Statement

Supporting Information

References

References

Related

Information