title: Multiple physical and mental health comorbidity in adults with intellectual disabilities: population-based cross-sectional analysis.
abstract: BACKGROUND
  Adults with intellectual disabilities have increased early mortality compared with the general population. However, their extent of multimorbidity (two or more additional conditions) compared with the general population is unknown, particularly with regards to physical ill-health, as are associations between comorbidities, neighbourhood deprivation, and age.
  
  
  METHODS
  We analysed primary health-care data on 1,424,378 adults registered with 314 representative Scottish practices. Data on intellectual disabilities, 32 physical, and six mental health conditions were extracted. We generated standardised prevalence rates by age-groups, gender, and neighbourhood deprivation, then calculated odds ratio (OR) and 95 % confidence intervals (95 % CI) for adults with intellectual disabilities compared to those without, for the prevalence, and number of condition.
  
  
  RESULTS
  Eight thousand fourteen (0.56 %) had intellectual disabilities, of whom only 31.8 % had no other conditions compared to 51.6 % without intellectual disabilities (OR 0.26, 95 % 0.25-0.27). The intellectual disabilities group were significantly more likely to have more conditions, with the biggest difference found for three conditions (10.9 % versus 6.8 %; OR 2.28, 95 % CI 2.10-2.46). Fourteen physical conditions were significantly more prevalent, and four cardiovascular conditions occurred less frequently, as did any cancers, and chronic obstructive pulmonary diseases. Five of the six mental health conditions were significantly more prevalent. For the adults with intellectual disabilities, no gradient was seen in extent of multimorbidity with increasing neighbourhood deprivation; indeed findings were similar in the most affluent and most deprived areas. Co-morbidity increased with age but is highly prevalent at all ages, being similar at age 20-25 to 50-54 year olds in the general population.
  
  
  CONCLUSIONS
  Multi-morbidity burden is greater, occurs at much earlier age, and the profile of health conditions differs, for adults with intellectual disabilities compared with the general population. There is no association with neighbourhood deprivation; people with intellectual disabilities need focussed services irrespective of where they live, and at a much earlier age than the general population. They require specific initiatives to reduce inequalities.
authors: Mental Health and Wellbeing group, Institute of Health and Wellbeing, University of Glasgow, Administrative Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK. Sally-Ann.Cooper@Glasgow.ac.uk.
authors: Sally-Ann
authors: SA
authors: Cooper
authors: General Practice and Primary Care group, Institute of Health and Wellbeing, University of Glasgow, 1, Horselethill Road, Glasgow, G12 9LX,, UK. Gary.McLean@Glasgow.ac.uk.
authors: Gary
authors: G
authors: McLean
authors: Quality, Safety and Informatics Research Group, Population Health Sciences Division, University of Dundee, Mackenzie Building Kirsty Semple Way, Dundee, DD2 4BF, UK. B.Guthrie@Dundee.ac.uk.
authors: Bruce
authors: B
authors: Guthrie
authors: Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Level 11, Boyd Orr Building, University Avenue, Glasgow, G12 8QQ, UK. Alex.McConnachie@Glasgow.ac.uk.
authors: Alex
authors: A
authors: McConnachie
authors: General Practice and Primary Care group, Institute of Health and Wellbeing, University of Glasgow, 1, Horselethill Road, Glasgow, G12 9LX,, UK. Stewart.Mercer@Glasgow.ac.uk.
authors: Stewart
authors: S
authors: Mercer
authors: UTOPIAN FMTU, North York General Hospital, Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M2K 1E1, Canada. Frank.sullivan@nygh.on.ca.
authors: Frank
authors: F
authors: Sullivan
authors: General Practice and Primary Care group, Institute of Health and Wellbeing, University of Glasgow, 1, Horselethill Road, Glasgow, G12 9LX,, UK. Jill.Morrison@Glasgow.ac.uk.
authors: Jill
authors: J
authors: Morrison
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D011320:Primary Health Care; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012737:Sex Factors; D055815:Young Adult