Multi-morbidity in a cohort of adults with intellectual disabilities, with and without Down syndrome


People with intellectual disabilities have different health needs and experience greater health inequalities when compared to the general population. Gastro-oesophageal reflux disorder, sensory impairments, osteoporosis, dental disease, musculoskeletal problems, accidents, and nutritional problems are all thought to be much more commonly experienced in people with intellectual disabilities. However, most studies have been small scale, with selected age groups, or methodologically limited. The aim of this paper is to report the physical health conditions of people with intellectual disabilities, with and without Down syndrome.

What we did

The analysis is part of a large prospective, cohort study. The adult population (aged 16 years and over) of people with intellectual disabilities living within the geographical area of Greater Glasgow Health Board, Scotland, were identified and recruited to the cohort study. Six nurses reviewed primary care case records, using a structured format and data collection form. Participants took part in a comprehensive semi-structured health interview and targeted physical examination assessment. Data analysis generated descriptive statistics about the physical ill-health and multi-morbidity of people with intellectual disabilities, with and without Down syndrome.

What we found

1,023 people with intellectual disabilities took part in the health assessment. 562 (54.9%) males and 461 (45.1%) females aged 43.9 years (16-83). 186 (18.2%) had a diagnosis of Down syndrome; 95 (51.5%) women and 91 (48.9%) men. A total of 16 International Classification of Diseases (ICD-10) physical health related chapters were recorded during health assessments. The average number of physical health conditions recorded was 11 and the majority of participants (98.7%) had multiple morbidities. The five most prevalent conditions recorded for adults with intellectual disabilities included: vision impairment (47%), obesity (41%), epilepsy (34.1%), constipation (33.8%) and ataxic/gait disorders (e.g. lack of muscle co-ordination) (29.9%). The most prevalent conditions are not only painful and/or disabling but in some cases potentially life threatening.

The extent of multi-morbidity in the adults with Down syndrome was similar to adults with intellectual disabilities without Down syndrome but patterns of disease clusters differed. Conditions that were prevalent in people with Down syndrome but not those without were: thyroid disorder (24.2%), skin infection (18.8%), congenital heart disease (16.1%) and pre-menstrual tension (13.4%). Further analysis will be presented.

What these findings mean

Using a robust study design in a large population, the high prevalence of multi-morbidity and health problems in this population are reported, many of which are preventable and amenable to treatment. This study also addresses an urgent need to better understand the pattern of multi-morbidity in adults with intellectual disabilities, with and without Down syndrome, which is important because it impacts on health care.

The original paper associated with this work can be found online at the BMJ Open. 

Page updated 10th November 2020.