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COVID-19’s hidden toll: Study reveals greater mortality disparities for individuals with mental disabilities

COVID-19’s hidden toll: Study reveals greater mortality disparities for individuals with mental disabilities

In a recent study published in The Lancet Public Health journal researchers analyzed cause-specific and any-cause mortality amongst individuals with or without intellectual-type disabilities before and through coronavirus disease 2019 (COVID-19).

Intellectually disabled individuals often have disparities in health attributable to barriers to accessing healthcare services or immunodeficiencies, which result in worse disease outcomes and early death. Increased COVID-19-associated mortality has been documented among the many disabled population between 2020 and 2021. Nevertheless, information on the magnitude of the impact on death disparities for disabled individuals is restricted.

Study: All-cause and cause-specific mortality amongst individuals with and without mental disabilities in the course of the COVID-19 pandemic within the Netherlands: a population-based cohort study. Image Credit: next143 / Shutterstock

In regards to the study

In the current study, researchers investigated whether there was a rise in cause-particular and any-cause mortality amongst individuals with mental disabilities in the course of the COVID-19 pandemic.

The team linked the adult Dutch population with the death registry of the Netherlands, comprising data on the demographics (age and sex), mental status based on the utilization of social services and chronic care services, and the cause and date of death for people who were deceased by December 31, 2021.

The findings during COVID-19 (January 1, 2020, and December 31, 2021) were compared with those before COVID-19 (between January 1, 2015, and December 31, 2019). The first study outcomes were cause-particular and all-cause mortality. Cox regression modeling was performed to calculate the mortality rates and hazard ratio (HR) values.

COVID-19-associated mortality was based on the International Classification of Diseases and Related Health Problems, tenth revision (ICD-10) codes. Mortality rates were calculated amongst every 10,000 individuals/12 months. As well as, the PubMed database was looked for English records published between the inception of the database and August 11, 2022.


In 2015, 187,149 adult Dutch residents with mental disability indicators and 13 million adults representing most people were recruited. The disabled population comprised 57% (n=107,370) of males and was younger in comparison with most people (mean age, 40 years versus 48 years). Between 2015 and 2021, 1,057,163 and 16,528 deaths amongst the final and disabled populations, respectively, were documented within the death register.

Within the pre-pandemic period, crude death rates amongst disabled adults (per 10,000 individuals/12 months) ranged from 110 to 132, and amongst most people, they ranged from 114 to 120. Within the pandemic period, the corresponding crude mortality rates ranged from 144 to 158, and from 133 to 136, respectively. Between 2020 and 2021, COVID-19 was the reason for death for 765 disabled adults and 166 to 178 non-disabled individuals. COVID-19-associated mortality was significantly greater among the many intellectually disabled population in comparison with most people (HR 4.9), with an especially large discrepancy at lower ages that reduced with advancing age.

On the entire, the disparity in mortality within the pandemic period (HR 3.4) was wider in comparison with that before COVID-19 (HR 3.2). Concerning disease groups reminiscent of behavioral, mental, and nervous system-associated causes; neoplasm-associated causes; non-natural or external causes; circulatory system-associated reasons; and natural or other causes), the mortality rate was more significant for intellectually disabled adults during COVID-19 in comparison with the pre-COVID-19 period.

The disparity in death rates between the 2 periods was greater among the many disabled population in comparison with most people, although the relative death risks for the vast majority of other causes were inside comparable ranges to the pre-COVID-19 years. The relative risk for COVID-19-associated deaths was more significant for disabled women (HR 6.2) in comparison with disabled men (HR 4.3). The disabled population died earlier (68 years) attributable to COVID-19 in comparison with the final population (82 years).

Noteworthy changes in the explanations for death amongst disabled adults included an increase in deaths from poorly defined neoplasms, fewer pneumonia-associated deaths, more deaths attributable to accidental falls, a rise in diabetes-associated deaths, and a decrease in deaths attributable to Down syndrome. A rise in deaths was reported attributable to unspecified reasons during COVID-19 in comparison with the pre-COVID-19 period. The info search yielded 76 records, of which 22 documented primary information on deaths from COVID-19.

Most studies analyzed data from the initial COVID-19 waves only, and only six records included data from the start of the pandemic through the initial months of 2021. 4 records reported any-cause mortality, and the opposite studies examined COVID-19 case fatalities for identifying risk aspects; nevertheless, none assessed cause-specific deaths attributable to non-COVID-19 reasons. The records indicated a greater mortality risk for disabled individuals, especially for Down syndrome patients and people residing in congregate-type settings. Studies addressing excessive deaths attributable to COVID-19 reported a positive association between the pandemic and intellectual-type disabilities.


Overall, the study findings showed that COVID-19 impacted intellectually disabled Dutch adults more severely than that indicated by documented COVID-19-associated deaths alone. The chance of COVID-19-associated death was more significant within the disabled population in comparison with most people, and the general disparities in mortality were further aggravated within the initial two years of COVID-19.

The health-associated risks for disabled adults warrant tailored policy formulation and decision-making concerning protective health measures to enhance global preparedness for COVID-19 and future pandemics. The findings highlight the necessity for higher monitoring at-risk individuals, including those with intellectual-type disabilities, who could also be ignored, with opposed consequences.


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