Abstract:
OBJECTIVES:To investigate mortality in adults with intellectual disabilities: rates, causes, place, demographic and clinical predictors. DESIGN:Cohort study with record linkage to death data. SETTING:General community. PARTICIPANTS:961/1023 (94%) adults (16-83 years; mean=44.1 years; 54.6% male) with intellectual disabilities, clinically examined in 2001-2004; subsequently record-linked to their National Health Service number, allowing linkage to death certificate data, 2018. OUTCOME MEASURES:Standardised mortality ratios (SMRs), underlying and all contributing causes of death, avoidable deaths, place, and demographic and clinical predictors of death. RESULTS:294/961 (30.6%) had died; 64/179 (35.8%) with Down syndrome, 230/783 (29.4%) without Down syndrome. SMR overall=2.24 (1.98, 2.49); Down syndrome adults=5.28 (3.98, 6.57), adults without Down syndrome=1.93 (1.68, 2.18); male=1.69 (1.42, 1.95), female=3.48 (2.90, 4.06). SMRs decreased as age increased. More severe intellectual disabilities increased SMR, but ability was not retained in the multivariable model. SMRs were higher for most International Statistical Classification of Diseases and Related Health Problems, 10th Revision chapters. For adults without Down syndrome, aspiration/reflux/choking and respiratory infection were the the most common underlying causes of mortality; for Down syndrome adults 'Down syndrome', and dementia were most common. Amenable deaths (29.8%) were double that in the general population (14%); 60.3% died in hospital. Mortality risk related to percutaneous endoscopic gastrostomy/tube fed, Down syndrome, diabetes, lower respiratory tract infection at cohort-entry, smoking, epilepsy, hearing impairment, increasing number of prescribed drugs, increasing age. Bowel incontinence reduced mortality risk. CONCLUSIONS:Adults with intellectual disabilities with and without Down syndrome have different SMRs and causes of death which should be separately reported. Both die younger, from different causes than other people. Some mortality risks are similar to other people, with earlier mortality reflecting more multimorbidity; amenable deaths are also common. This should inform actions to reduce early mortality, for example, training to avoid aspiration/choking, pain identification to address problems before they are advanced, and reasonable adjustments to improve healthcare quality.
journal_name
BMJ Openjournal_title
BMJ openauthors
Cooper SA,Allan L,Greenlaw N,McSkimming P,Jasilek A,Henderson A,McCowan C,Kinnear D,Melville Cdoi
10.1136/bmjopen-2019-036465subject
Has Abstractpub_date
2020-05-17 00:00:00pages
e036465issue
5issn
2044-6055pii
bmjopen-2019-036465journal_volume
10pub_type
杂志文章相关文献
BMJ Open文献大全abstract:OBJECTIVES:The rate of total knee arthroplasty surgery (TKA) is rising in Australia despite varying impacts of TKA on physical function (PF) in population-based studies. There are potentially modifiable risk factors that could enhance PF after TKA, so we evaluated (1) the levels of PF in persons with TKA and the rest o...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2012-002291
更新日期:2013-07-08 00:00:00
abstract:OBJECTIVE:To investigate whether two primary care activities that are framed as indicators of primary care quality (comprehensive care plans and annual reviews of physical health) influence unplanned utilisation of hospital services for people with serious mental illness (SMI). DESIGN, SETTING, PARTICIPANTS:Retrospect...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-023135
更新日期:2018-11-28 00:00:00
abstract:INTRODUCTION:Malnutrition among children is a serious public health problem in the aftermath of any natural disaster. We will review the various nutrition interventions for children aged <5 years in countries where natural disasters occurred and analyse the effect on nutrition-related outcomes. METHODS AND ANALYSIS:We...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2015-009525
更新日期:2015-11-30 00:00:00
abstract:OBJECTIVE:To explore the optimal content and design of a clinical trial of an end-of-life intervention for advanced heart disease with patients, carers and healthcare professionals. DESIGN:Qualitative interview and focus group study. SETTING:Community and hospital-based focus groups and interviews. PARTICIPANTS:Stab...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2014-005021
更新日期:2014-07-14 00:00:00
abstract:OBJECTIVES:Although the smoking prevalence continues to decline in New Zealand (NZ) overall, little is known about smoking in university students. A 2013 survey of students aged 17-25 years found that 14% were current smokers, and 3% daily smokers. However, the sample did not include students from all NZ universities. ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-032590
更新日期:2019-12-18 00:00:00
abstract:OBJECTIVES:To estimate hepatitis B vaccination (HBVc) coverage, and knowledge and sociodemographic determinants of full dose uptake in Federal Road Safety Corps (FRSC) members, Kaduna State, Nigeria, to inform relevant targeted vaccination policies. DESIGN:A cross sectional survey of FRSC members, Kaduna Sector Comman...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-015845
更新日期:2017-06-02 00:00:00
abstract:OBJECTIVE:The aim of the present study was to investigate the prevalence of abnormal cholesterol levels and to explore awareness of cholesterol values in an unselected sample of community-living adults. DESIGN:Cross-sectional survey. SETTING:Exhibitions, malls and health promotion campaigns across Italy. PARTICIPANT...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-021627
更新日期:2018-06-30 00:00:00
abstract:BACKGROUND:Jordan, a Middle Eastern country, declared a state of national emergency due to COVID-19 and a strict nationwide lockdown on 17 March 2020, banning all travel and movement around the country, potentially impacting mental health. This study sought to investigate the association between mental health (eg, anxi...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-041995
更新日期:2020-12-22 00:00:00
abstract:INTRODUCTION:Sarcoidosis is an incurable, chronic granulomatous disease primarily involving the lungs and lymph nodes of unknown aetiology, treated with non-specific anti-inflammatory/immunosuppressive drugs. Persistently symptomatic patients worsen with a disabling, potentially fatal clinical course. To determine a po...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2013-004065
更新日期:2013-12-23 00:00:00
abstract:INTRODUCTION:Perioperative benzodiazepines are used because of their anxiolytic, sedative and amnestic effects. Evidence has demonstrated an association of benzodiazepines with adverse neuropsychiatric effects. Nonetheless, because of their potential benefits, perioperative benzodiazepines continue to be used routinely...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-031895
更新日期:2019-12-11 00:00:00
abstract:OBJECTIVES:The main purpose of the present study was to explore the associations between sleep quality and insufficient physical activity. DESIGN:Cross-sectional. SETTING:Faculties in Croatia. PARTICIPANTS:2100 university students (1049 men and 1051 women) aged 18-24 years were recruited. PRIMARY OUTCOME:To assess ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-021902
更新日期:2018-07-13 00:00:00
abstract:OBJECTIVE:To analyse voluntary payment reports of pharmaceutical companies to German healthcare professionals (HCPs) in 2015 and 2016 based on an industry-self-regulating transparency codex. DESIGN AND PARTICIPANTS:Cohort study of all German HCPs who voluntarily agreed that at least one payment they received in 2015 a...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-037395
更新日期:2020-09-17 00:00:00
abstract:OBJECTIVES:This study examined National Health Insurance claims data to investigate the epidemiology of shoulder disorders in Korea. Detailed information on medical services and related costs was assessed by major shoulder disorder category. DESIGN AND SETTING:The 2014 National Patient Sample dataset provided by the H...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-015848
更新日期:2017-07-12 00:00:00
abstract:OBJECTIVES:To determine whether a pre-existing smartphone app to teach mindfulness meditation is acceptable to women with chronic pelvic pain (CPP) and can be integrated into clinical practice within the National Health Service (NHS) CPP pathways, and to inform the design of a potential randomised clinical trial. DESI...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-030711
更新日期:2020-03-12 00:00:00
abstract:OBJECTIVE:To explore the feasibility of health systems strengthening from the perspective of international healthcare implementers and donors in South Sudan. DESIGN:A qualitative interview study, with thematic analysis using the WHO health system building blocks framework. SETTING:South Sudan. PARTICIPANTS:17 health...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2015-009296
更新日期:2015-12-23 00:00:00
abstract:INTRODUCTION:The health workforce is an integral component of the healthcare system. Comprehensive, high-quality data on the health workforce are essential to identifying gaps in health service provision, as well as informing future health workforce and health services planning, and health policy. While many data sourc...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-034400
更新日期:2020-01-21 00:00:00
abstract:OBJECTIVES:Improving outcomes for older people with long-term conditions and multimorbidity is a priority. Current policy commits to substantial expansion of social prescribing to community assets, such as charity, voluntary or community groups. We use longitudinal data to add to the limited evidence on whether this is...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-033186
更新日期:2020-02-06 00:00:00
abstract:OBJECTIVES:To identify the determinants of antenatal care (ANC) utilisation in sub-Saharan Africa. DESIGN:Systematic review. DATA SOURCES:Databases searched were PubMed, OVID, EMBASE, CINAHL and Web of Science. ELIGIBILITY CRITERIA:Primary studies reporting on determinants of ANC utilisation following multivariate a...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-031890
更新日期:2019-10-07 00:00:00
abstract:OBJECTIVES:Isoniazid preventive therapy (IPT), for people living with HIV (PLHIV) is the proven and recommended intervention to avert tuberculosis (TB). In 2015, Nepal implemented 6 months of IPT for all PLHIV registered for HIV care in antiretroviral therapy (ART) centres. After programmatic implementation, there has ...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2019-029058
更新日期:2019-05-29 00:00:00
abstract:OBJECTIVES:To describe the current provision of hospital-based liaison psychiatry services in England, and to determine different models of liaison service that are currently operating in England. DESIGN:Cross-sectional observational study comprising an electronic survey followed by targeted telephone interviews. SET...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-023091
更新日期:2018-09-01 00:00:00
abstract:OBJECTIVE:Exploring the views of stakeholders to the referral management systems (RMS) used by GP practices in Northumberland, UK to evaluate its perceived effectiveness. DESIGN:This was an in-depth qualitative semi-structured interview study. PARTICIPANTS AND SETTING:32 participants (GPs, hospital consultants, refer...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-028436
更新日期:2019-07-09 00:00:00
abstract:OBJECTIVES:To develop a better understanding of general practitioners' (GPs) views and experiences of the management of patients with headaches and use of direct-access MRI scans, and observe outcomes of an educational session offered by a GP with a special interest (GPwSI) to GPs. DESIGN:A qualitative study using sem...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-018169
更新日期:2017-11-09 00:00:00
abstract:OBJECTIVE:To describe and analyse the hospitalisation cost of patients with hip fracture under the influence of various factors and to provide references for Chinese national medical insurance policy. MATERIALS AND METHODS:All data were collected from the Chinese National Medical Data Centre database, which contained ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-019147
更新日期:2018-04-27 00:00:00
abstract:OBJECTIVES:The research aimed to support the effectiveness and necessity of the communication training and methodology introduced in the postgraduate pharmacy training and community pharmacy practice in Hungary. DESIGN:Two cross-sectional questionnaire surveys before and after the introduction of a methodological reco...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-039603
更新日期:2020-12-08 00:00:00
abstract:OBJECTIVES:To validate the performance of a set of risk prediction algorithms developed using the QResearch database, in an independent sample from general practices contributing to the Clinical Research Data Link (CPRD). SETTING:Prospective open cohort study using practices contributing to the CPRD database and pract...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2014-005809
更新日期:2014-08-28 00:00:00
abstract:INTRODUCTION:Tranexamic acid (TXA) is a synthetic derivative of the amino acid lysine that inhibits fibrinolysis by blocking lysine-binding sites on plasminogen, which contribute to reduced bleeding, the need for transfusion and mortality. Although there is reliable evidence of the efficacy of TXA, its effects on other...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-036020
更新日期:2020-06-22 00:00:00
abstract:INTRODUCTION:Prescription-drug use in the USA has increased by more than 60% in the last three decades. Prevalence of prescription-drug use among pregnant women is currently estimated around 50%. Prevalence of illicit drug use in the USA is 14.6% among pregnant adolescents, 8.6% among pregnant young adults and 3.2% amo...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2017-020248
更新日期:2018-02-17 00:00:00
abstract:OBJECTIVE:Occupational therapy is often prescribed after the acute treatment of upper extremity fractures. However, high out-of-pocket expenses and logistical constraints can reduce access to formal therapy services. We aimed to quantify preferences of patients with upper extremity fracture for attending occupational t...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-039888
更新日期:2020-10-14 00:00:00
abstract:INTRODUCTION:Atrial fibrillation (AF) is one of the leading causes of cerebrovascular mortality and morbidity. Oral anticoagulants (OACs) have been shown to reduce the incidence of cardioembolic stroke in patients with AF, adherence to treatment being an essential element for their effectiveness. Since the release of t...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-025102
更新日期:2018-12-19 00:00:00
abstract:INTRODUCTION:The incidence of head and neck cancer (HNC) in the UK is rising, with an average of 31 people diagnosed daily. Patients affected by HNC suffer significant short-term and long-term post-treatment morbidity as a result of dysphagia, which affects daily functioning and quality of life (QOL). Pretreatment swal...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2016-014167
更新日期:2017-03-27 00:00:00