Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, SE-901 87, Umeå, Sweden.
Centre for Demographic and Ageing Research, Umeå University, SE-901 87, Umeå, Sweden.
BMC Geriatr. 2017 Nov 22;17(1):269. doi: 10.1186/s12877-017-0665-3.
Sweden has closed all institutions and imposed legislation to ensure service and support for individuals with intellectual disability (ID). Understanding mortality among older individuals with ID is essential to inform development of health promotion and disease control strategies. We investigated patterns and risk of mortality among older adults with ID in Sweden.
This retrospective cohort study compared older adults aged 55 years and older with ID with a control population. Participants were followed during 2002-2015 or death, and censored if they moved out of Sweden. Individuals with ID were identified from two national registers: one covering all specialist health-care visits (out-patient visits and hospitalisation) and the other covering people accessing social/support services. Individuals with ID (n = 15,289) were matched with a control population by sex, birth year, and year of first hospitalisation/out-patient visit/access to LSS services. Cause-of-death data were recorded using International Classification of Diseases, Tenth Revision. Cox proportional hazards regression were conducted to assess if overall and cause-specific mortality rate among individuals with ID was higher than in the Swedish population.
The overall mortality rate among individuals with ID was 2483 per 100,000 people compared with 810 in the control population. Among those who died, more individuals with ID were younger than 75 years and unmarried. Leading causes of death among individuals with ID were circulatory diseases (34%), respiratory diseases (17%) and neoplasms (15%). Leading causes of death in a sub-sample with Down syndrome (DS) were respiratory diseases (37%), circulatory diseases (26%) and mental/behavioural disorders (11%). Epilepsy and pneumonitis were more common among individuals with ID than controls. Alzheimer's disease was common in the control population and individuals with DS, but not among those with ID when DS was excluded. Individuals with ID had a higher overall mortality risk (hazard ratio [HR] 4.1, 95% confidence interval [CI] 4.0-4.3) and respiratory disease death risk (HR 12.5, 95% CI 10.9-14.2) than controls.
Older adults with ID in Sweden carry a higher mortality risk compared with the general population, mainly attributable to respiratory, nervous and circulatory diseases. Care for this group, particularly during the terminal stage of illness, needs to be tailored based on understanding of their main health problem.
瑞典已经关闭了所有机构，并制定了立法，以确保为智障人士（ID）提供服务和支持。了解老年智障人士的死亡率对于制定健康促进和疾病控制策略至关重要。我们调查了瑞典老年智障人士的死亡率模式和风险。
这是一项回顾性队列研究，比较了年龄在 55 岁及以上的智障成年人和对照组人群。参与者在 2002 年至 2015 年期间或死亡时进行随访，并在他们搬出瑞典时进行了删失。智障人士是从两个国家登记处确定的：一个涵盖所有专科保健就诊（门诊就诊和住院），另一个涵盖获得社会/支持服务的人。智障人士（n=15289）根据性别、出生年份和首次住院/门诊就诊/获得 LSS 服务的年份与对照组进行匹配。死因数据使用国际疾病分类，第十次修订版记录。使用 Cox 比例风险回归评估智障人士的总体和特定原因死亡率是否高于瑞典人口。
智障人士的总体死亡率为每 100,000 人 2483 人，而对照组为 810 人。在死亡的人中，更多的智障人士年龄小于 75 岁且未婚。智障人士的主要死因是循环系统疾病（34%）、呼吸系统疾病（17%）和肿瘤（15%）。唐氏综合征（DS）亚组的主要死因是呼吸系统疾病（37%）、循环系统疾病（26%）和精神/行为障碍（11%）。癫痫和肺炎在智障人士中比对照组更常见。阿尔茨海默病在对照组和 DS 人群中很常见，但在排除 DS 后，在智障人士中并不常见。智障人士的总体死亡率风险（危险比[HR]4.1，95%置信区间[CI]4.0-4.3）和呼吸系统疾病死亡风险（HR 12.5，95%CI 10.9-14.2）均高于对照组。
瑞典的老年智障人士的死亡率高于一般人群，主要归因于呼吸系统、神经系统和循环系统疾病。需要根据了解他们的主要健康问题，为这群人提供量身定制的护理，特别是在疾病的终末期。
