A known label: an explanation that excludes nothing

Review and sources

Not clinically reviewed. No clinician has signed this scenario.

• Kinnear D, Morrison J, Allan L, Henderson A, Smiley E, Cooper SA. Prevalence of physical conditions and multimorbidity in a cohort of adults with intellectual disabilities with and without Down syndrome: cross-sectional study. BMJ Open. 2018;8(2):e018292. Large population-based cross-sectional study in the geographical area of one Scottish Health Board; all adults aged 16 and over known to general practitioners to have intellectual disabilities or receiving intellectual disabilities services were eligible, and 1,023 of 1,562 took part (65.5%), 562 men and 461 women, mean age 43.9 years, of whom 186 had Down syndrome. At comprehensive health assessment the mean number of physical health conditions per participant was 11.04 and 98.7% had multimorbidity. The five most prevalent conditions were visual impairment, obesity, epilepsy, constipation and ataxic/gait disorders. The pattern of multimorbidity differed from that in the general population and was spread across the entire adult life course.
• Heslop P, Blair PS, Fleming P, Hoghton M, Marriott A, Russ L. The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study. Lancet. 2014;383(9920):889-95. Population-based confidential inquiry reviewing the deaths of 247 people with intellectual disabilities aged 4 and over registered with a general practitioner in five Primary Care Trust areas of southwest England who died between June 2010 and May 2012, with a comparator group of people without intellectual disabilities matched for age, sex, cause of death and general practice. Nearly a quarter (22%, 54) were younger than 50 at death; median age at death was 64 years, against 78 for men and 83 for women in the general population of England and Wales. Deaths from causes amenable to change by good quality health care were more common in people with intellectual disabilities (37%, 90 of 244) than in the general population (13%). Contributory factors that differed significantly from the comparator group included problems in advanced care planning (p=0.0003), adherence to the Mental Capacity Act (p=0.0008), living in inappropriate accommodation (p<0.0001), adjusting care as needs changed (p=0.009), and carers not feeling listened to (p=0.006).
• Lee AC, Herrieven E, Harrower NA. Health inequalities for people with learning disabilities: why it matters and what emergency physicians need to know. Br J Hosp Med (Lond). 2024;85(2):1-7. Narrative review for emergency physicians. It reports that people with learning disabilities in England die on average 16 years earlier than the general population, describes premature deaths with contributory healthcare causes, and names diagnostic overshadowing leading to delayed or missed diagnoses alongside a lack of reasonable adjustments, polypharmacy, and inappropriate use of do-not-resuscitate orders. It states that carers and family can be vital informants, helping clinicians interpret subtle signs, and that clinicians should be aware of subtle or atypical presentations of illness. This is a narrative review rather than a measurement study, and is quoted here for its framing rather than as evidence of effect size.