Thygesen Lau Caspar, Klitgaard Marie Borring, Sabers Anne, Kjellberg Jakob, Søndergaard Jens, Sørensen Jeppe, Sonne Marie, Juel Knud, Michelsen Susan Ishøy
National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
The Epilepsy Clinic, Department of Neurology, Rigshospital University Hospital, Copenhagen, Denmark.
Eur J Public Health. 2024 Dec 1;34(6):1225-1231. doi: 10.1093/eurpub/ckae118.
Persons with intellectual disabilities (ID) face pronounced health disparities. The aim of this study was to describe premature mortality by causes of death and avoidable mortality among persons with ID compared to the general Danish population. This study is based on a Danish nationwide cohort of adults (aged 18-74 years) with ID (n = 57 663) and an age- and sex-matched reference cohort (n = 607 097) which was established by linkage between several registers. The cohorts were followed in the Register of Causes of Death between 2000 and 2020. Causes of death were categorized into preventable, treatable, or unavoidable deaths using the OECD/Eurostat classification and furthermore categorized into specific interventions. We compared the observed and expected number of deaths by calculating standardized mortality ratio (SMR). Among persons with ID the number of deaths was 9400 whereof 5437 (58%) were avoidable. SMR for preventable deaths, e.g. by reducing smoking and alcohol intake or by vaccination, was 2.62 (95% CI, 2.51-2.73), and SMR for treatable deaths, e.g. by earlier diagnosis and treatment, was 6.00 (5.72-6.29). Unavoidable mortality was also six-fold increased (SMR = 6.03; 5.84-6.22). Preventable deaths were higher for persons with mild ID compared to severe ID, while treatable and unavoidable mortality were highest for persons with severe ID. The study confirmed that persons with ID have an amplified risk of mortality across all categories. There is a need for competence development of social care and healthcare personnel and reasonable adjustment of health promotion programs and healthcare services for people with ID.
智障人士面临着明显的健康差距。本研究的目的是描述与丹麦普通人群相比，智障人士按死因划分的过早死亡率以及可避免的死亡率。本研究基于丹麦全国范围内一组18至74岁的成年智障人士队列（n = 57663）以及一个年龄和性别匹配的对照队列（n = 607097），该对照队列通过几个登记册之间的关联建立。这些队列在2000年至2020年期间在死因登记册中进行随访。死因被使用经合组织/欧盟统计局的分类法分为可预防、可治疗或不可避免的死亡，并进一步分为具体的干预措施。我们通过计算标准化死亡率（SMR）来比较观察到的和预期的死亡人数。在智障人士中，死亡人数为9400人，其中5437人（58%）的死亡是可避免的。例如通过减少吸烟和饮酒或接种疫苗来预防的死亡的SMR为2.62（95%可信区间，2.51 - 2.73），例如通过早期诊断和治疗来治疗的死亡的SMR为6.00（5.72 - 6.29）。不可避免的死亡率也增加了六倍（SMR = 6.03；5.84 - 6.22）。轻度智障人士的可预防死亡高于重度智障人士，而重度智障人士的可治疗和不可避免死亡率最高。该研究证实，智障人士在所有类别中都有更高的死亡风险。需要对社会护理和医疗保健人员进行能力培养，并对针对智障人士的健康促进计划和医疗服务进行合理调整。
