title: Health care provision for people with a learning disability. Record-linkage study of epidemiology and factors contributing to hospital care uptake.
abstract: BACKGROUND
  We know little about how people with a learning disability access secondary health care.
  
  
  OBJECTIVE
  To describe the epidemiology of learning disability, the influence of deprivation on prevalence and the pattern of secondary care uptake, including the effect of institutionalisation.
  
  
  METHODS
  A record-linkage study of secondary care contacts of 434,000 people between 1991 and 1997. A population with learning disability was identified; their secondary care contact was calculated and compared with the general population's.
  
  
  RESULTS
  The distribution of people with a learning disability (n = 1595) correlated significantly with deprivation. The presence of a learning disability hospital significantly affected care uptake. Place of residence also affected acute admission to the learning disability hospital. Former institution residents generated 212 admissions per 1000 patients; community patients generated 18 per 1000. The admission rate with any psychiatric diagnosis to any setting was 26.3 per 1000 people with a learning disability; 16.5% of such patients had a dual diagnosis.
  
  
  CONCLUSIONS
  Health provision for people with a learning disability is affected by institutional provision.
authors.affiliation: Department of General Medicine, University Hospital of Wales, Cardiff.
authors.forename: C L
authors.initials: CL
authors.lastname: Morgan
authors.forename: Z
authors.initials: Z
authors.lastname: Ahmed
authors.forename: M P
authors.initials: MP
authors.lastname: Kerr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007859:Learning Disabilities / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D015995:Prevalence; D012959:Socioeconomic Factors; D014852:Wales / Q000453:epidemiology