# Hospitalisation rates for epilepsy, asthma and insulin-dependent diabetes in 796 190 school-aged children and young people with and without intellectual disabilities: a record-linkage cohort study

## TL;DR

Children with intellectual disabilities in Scotland are more likely to be hospitalized for epilepsy and asthma compared to their peers, suggesting potential gaps in community healthcare.

## Contribution

This study is the first to compare hospitalization rates for epilepsy, asthma, and diabetes in children with and without intellectual disabilities using a large Scottish cohort.

## Key findings

- Children with intellectual disabilities had higher rates of epilepsy and asthma compared to peers without disabilities.
- Hospital admissions for epilepsy were more frequent and longer for children with intellectual disabilities.
- Asthma admissions were similar in frequency but longer in duration for children with intellectual disabilities.

## Abstract

To investigate hospitalisation rates for the ambulatory care-sensitive conditions of epilepsy, asthma and insulin-dependent diabetes in school-aged children and young people with intellectual disabilities in comparison with their peers.

Record-linkage cohort study. Scotland’s Pupil Census, 2008–2013, was used to identify pupils with and without intellectual disabilities and was linked with the Prescribing Information Service to identify pupils with epilepsy, asthma and insulin-dependent diabetes, and the Scottish Morbidity Records-01 to identify hospital admissions.

The general child population of Scotland.

School pupils aged 4–19 years; 18 278 with intellectual disabilities and 777 912 without intellectual disabilities.

Overall, emergency and non-emergency hospitalisations for epilepsy, asthma and/or diabetes; and length of stay.

Epilepsy and asthma were more prevalent in pupils with intellectual disabilities (8.8% and 8.9%, respectively, compared with 0.8% and 6.9% among pupils without intellectual disabilities, p<0.001), whereas insulin-dependent diabetes was not (0.5% prevalence). After adjusting for prevalence, pupils with intellectual disabilities and epilepsy had more epilepsy-related admissions than their peers (adjusted Hazard Ratio (aHR) 2.24, 95% CI 1.97, 2.55). For emergency admissions, these stays were longer compared with controls (adjusted incidence rate ratio (aIRR) 2.77, 95% CI 2.13, 3.59). Pupils with intellectual disabilities and asthma had similar admission rates due to asthma as control pupils with asthma (aHR 0.81, 95% CI 0.62, 1.06), but emergency admissions were longer (aIRR 2.72, 95% CI 1.49, 4.96). Pupils with intellectual disabilities and insulin-dependent diabetes had similar admission rates to controls (aHR 0.94, 95% CI 0.63, 1.41) but with shorter admissions (aIRR 0.71, 95% CI 0.51, 0.99).

Our findings suggest pupils with intellectual disabilities may receive poorer community healthcare than their peers for the common conditions of epilepsy and asthma. Hospital admissions are disruptive for both the child and their family. Epilepsy and asthma are associated with avoidable deaths; hence, a better understanding of these hospitalisations is important.