Objective To assess the association between learning disability and risk of hospital admission and death from covid-19 in England among adults and children. Design Population based cohort study on behalf of NHS England using the OpenSAFELY platform. Setting Patient level data were obtained for more than 17 million people registered with a general practice in England that uses TPP software. Electronic health records were linked with death data from the Office for National Statistics and hospital admission data from NHS Secondary Uses Service. Participants Adults (aged 16-105 years) and children (<16 years) from two cohorts: wave 1 (registered with a TPP practice as of 1 March 2020 and followed until 31 August 2020); and wave 2 (registered 1 September 2020 and followed until 8 February 2021). The main exposure group consisted of people on a general practice learning disability register; a subgroup was defined as those having profound or severe learning disability. People with Down’s syndrome and cerebral palsy were identified (whether or not they were on the learning disability register). Main outcome measure Covid-19 related hospital admission and covid-19 related death. Non-covid-19 deaths were also explored. Results For wave 1, 14 312 023 adults aged ≥16 years were included, and 90 307 (0.63%) were on the learning disability register. Among adults on the register, 538 (0.6%) had a covid-19 related hospital admission; there were 222 (0.25%) covid-19 related deaths and 602 (0.7%) non-covid deaths. Among adults not on the register, 29 781 (0.2%) had a covid-19 related hospital admission; there were 13 737 (0.1%) covid-19 related deaths and 69 837 (0.5%) non-covid deaths. Wave 1 hazard ratios for adults on the learning disability register (adjusted for age, sex, ethnicity, and geographical location) were 5.3 (95% confidence interval 4.9 to 5.8) for covid-19 related hospital admission and 8.2 (7.2 to 9.4) for covid-19 related death. Wave 2 produced similar estimates. Associations were stronger among those classified as having severe to profound learning disability, and among those in residential care. For both waves, Down’s syndrome and cerebral palsy were associated with increased hazards for both events; Down’s syndrome to a greater extent. Hazard ratios for non-covid deaths followed similar patterns with weaker associations. Similar patterns of increased relative risk were seen for children, but covid-19 related deaths and hospital admissions were rare, reflecting low event rates among children. Conclusions People with learning disability have markedly increased risks of hospital admission and death from covid-19, over and above the risks observed for non-covid causes of death. Prompt access to covid-19 testing and healthcare is warranted for this vulnerable group, and prioritisation for covid-19 vaccination and other targeted preventive measures should be considered. All data were linked, stored and analysed securely within the OpenSAFELY platform (). Data include pseudonymised data such as coded diagnoses, drugs, and physiological parameters. No free text data are included. All code is shared openly for review and reuse under MIT open license (). Detailed pseudonymised patient data are potentially reidentifiable and therefore not shared. We rapidly delivered the OpenSAFELY data analysis platform without prior funding to deliver timely analyses on urgent research questions in the context of the global covid-19 health emergency: now that the platform is established we are developing a formal process for external users to request access in collaboration with NHS England; details of this process will be published shortly on .

中文翻译：

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有学习障碍的人因 covid-19 入院和死亡的风险：使用 OpenSAFELY 平台进行的基于人群的队列研究

目的 评估英格兰成人和儿童学习障碍与 covid-19 住院和死亡风险之间的关联。使用 OpenSAFELY 平台代表英格兰 NHS 设计基于人群的队列研究。设置 在使用 TPP 软件的英格兰全科诊所注册的超过 1700 万人中获得了患者水平数据。电子健康记录与国家统计办公室的死亡数据和 NHS 二次利用服务的入院数据相关联。参与者来自两个队列的成人（16-105 岁）和儿童（<16 岁）：第 1 波（截至 2020 年 3 月 1 日在 TPP 实践中注册，跟踪至 2020 年 8 月 31 日）；和第 2 波（于 2020 年 9 月 1 日注册，并持续至 2021 年 2 月 8 日）。主要接触组由全科学习障碍登记册上的人员组成；一个亚组被定义为那些有严重或严重学习障碍的人。患有唐氏综合症和脑瘫的人被识别出来（无论他们是否在学习障碍登记册上）。主要结局指标是与 Covid-19 相关的入院和与 Covid-19 相关的死亡。还探讨了非 covid-19 死亡事件。结果 第 1 波纳入了 14 312 023 名 16 岁以上成年人，其中 90 307 名 (0.63%) 被列入学习障碍登记册。在登记的成年人中，有 538 名 (0.6%) 因与 covid-19 相关而入院；有 222 例 (0.25%) 与 covid-19 相关的死亡和 602 例 (0.7%) 非 covid 死亡。在未登记的成年人中，有 29 781 人 (0.2%) 因与 covid-19 相关而入院；共有 13 737 例 (0.1%) 与 covid-19 相关的死亡和 69 837 例 (0.5%) 非 covid 死亡。学习障碍登记册上的成年人的第一波风险比（根据年龄、性别、种族和地理位置进行调整）对于 covid-19 相关入院为 5.3（95% 置信区间 4.9 至 5.8），对于与 covid-19 相关的入院为 8.2（7.2 至 9.4）。 covid-19 相关死亡。第二波也产生了类似的估计。在那些被归类为严重至极重度学习障碍的人以及那些接受住院护理的人中，关联性更强。对于这两种波，唐氏综合症和脑瘫都与这两种事件的危险增加有关；唐氏综合症程度更大。非新冠死亡的风险比遵循类似的模式，但关联性较弱。儿童中也出现了类似的相对风险增加模式，但与 covid-19 相关的死亡和住院情况很少见，反映出儿童的事件发生率较低。结论 有学习障碍的人因 covid-19 入院和死亡的风险显着增加，超过了观察到的非 covid 死亡原因的风险。该弱势群体需要及时获得 covid-19 检测和医疗保健，并应考虑优先接种 covid-19 疫苗和其他有针对性的预防措施。所有数据均已链接，）。数据包括假名数据，例如编码诊断、药物和生理参数。不包含自由文本数据。所有代码均在 MIT 开放许可证下公开共享，以供审查和重用（）。详细的假名患者数据可能会被重新识别，因此不会共享。我们在没有事先资金的情况下快速交付了 OpenSAFELY 数据分析平台，以便在全球 covid-19 卫生紧急情况下对紧急研究问题进行及时分析：现在该平台已建立，我们正在开发一个正式流程，供外部用户请求访问与英格兰 NHS 合作；该过程的详细信息将很快发布在。