Skåne cohort study finds higher COVID-19 hospitalization risk and mortality in selected groups of people with intellectual disability

A population-based register cohort study in Skåne, Sweden, found that people with intellectual disabilities had a higher likelihood of receiving a COVID-19 diagnosis and hospitalization during 2020 and 2021 than the general population. Mortality comparisons were possible only in selected age- and sex-specific groups because relatively few people with intellectual disabilities died from COVID-19.

The study included 14,046 people with intellectual disabilities who were alive on January 1, 2020, and 13,919 who were alive on January 1, 2021. The general-population comparison cohort comprised 1,157,112 people in 2020 and 1,144,826 in 2021. It excluded people in the intellectual disability cohort and people belonging to the same family or household as someone in that cohort.

Cohort membership was determined from diagnoses of intellectual disability or Down syndrome recorded between 2014 and 2021 and from receipt of services or support under Sweden’s LSS act. The researchers collected outcome data for 2020 and 2021 from Swedish national and regional registers. Outcomes included COVID-19 diagnoses, laboratory identification of the virus, physical primary-care visits, hospitalizations, bed days, death with COVID-19 as the primary cause and receipt of at least one vaccine dose.

Poisson regression was used to estimate relative risks and 95% confidence intervals for the intellectual disability cohort compared with the general population. Analyses were stratified by sex and age group, with age adjustment where appropriate, and results were reported only for groups containing at least five people. Vaccination was assessed in 2021 because no COVID-19 vaccines had been registered in 2020.

People with intellectual disabilities generally had a higher likelihood of receiving a COVID-19 diagnosis in both years, with statistically significant increases in most sex and age groups other than boys. Older people with intellectual disabilities were approximately 3.5 to 4.5 times as likely as their general-population peers to be diagnosed. They were also less likely to have the virus identified by laboratory testing, except among older women in 2020. In 2020, adults with intellectual disabilities were about 50% less likely to have a laboratory-confirmed diagnosis, while the corresponding relative risk among older people in 2021 was about 70% lower for both men and women.

COVID-19-related primary-care utilization was higher in several groups. Older men and women with intellectual disabilities were about five to six times as likely as comparable general-population peers to have at least one physical primary-care visit with COVID-19 as the primary diagnosis in 2020. Adult men with intellectual disabilities also had a higher likelihood of such a visit in both years—approximately threefold higher in 2020 and twofold higher in 2021. Among people with at least one visit, however, some groups with intellectual disabilities had fewer contacts than their peers: adult men and women had contact rates 14% and 18% lower in 2020, and adult men had a rate 7% lower in 2021.

Across all groups for which comparisons could be made, people with intellectual disabilities had a significantly higher likelihood of at least one COVID-19 hospitalization than the general population in 2020 and 2021, with no statistically significant differences by sex or age group in these analyses. Among people who had been hospitalized, older men with intellectual disabilities had a 56% lower rate of hospital bed days in 2020 than their general-population counterparts. Analyses for children and for older women with intellectual disabilities in 2021 were not conducted because the numbers were too low.

The intellectual disability cohort recorded 28 deaths with COVID-19 as the primary cause, compared with 1,664 in the general population: 11 versus 798 in 2020 and 17 versus 866 in 2021. Older men with intellectual disabilities had more than five times the risk of COVID-19-related death than older men in the general population in 2020. In 2021, adult men and women with intellectual disabilities had approximately 20 and 40 times the risk, respectively, of their general-population counterparts. No children in either cohort died with COVID-19 as the primary cause during either year, and too few other deaths in the intellectual disability cohort supported further comparisons.

Vaccination coverage was broadly similar between the cohorts after adjustment. Adults with intellectual disabilities were approximately 4% more likely than general-population adults to have received at least one dose in 2021, while no statistically significant differences were observed among older people. Adjusted uptake was lower among children with intellectual disabilities, with a statistically significant 9% difference among boys and a nonsignificant 5% difference among girls. Cumulative prevalence curves showed that people with intellectual disabilities generally received their first dose earlier than the general population.

The findings are constrained by the relatively small number of hospitalizations and deaths in the intellectual disability cohort, which prevented some comparisons and left an incomplete mortality pattern. Only age and sex were considered as potential confounders, leaving factors such as intellectual disability severity, comorbidities and living arrangements unaccounted for. Diagnostic information from private healthcare providers was unavailable, potentially underestimating COVID-19 prevalence. The cohort definition could also include people whose intellectual disability diagnosis was first recorded in 2021, while symptom-based clinical diagnoses may differ in specificity from laboratory-confirmed cases. The authors concluded that Sweden’s vaccination and healthcare-prioritization strategy appeared to have worked as intended, while noting that higher mortality and fewer contacts among some people receiving care require further attention.

Subject of Research: COVID-19 diagnoses, healthcare use, mortality and vaccination among people with intellectual disabilities in Skåne, Sweden, 2020–2021

Article Title: COVID-19 among people with intellectual disability in comparison to the general population: diagnoses, hospitalizations, deaths, and vaccinations (IDcare)

Article References: Sandberg, M., Kristensson, J., & Axmon, A. (2026). COVID-19 among people with intellectual disability in comparison to the general population: diagnoses, hospitalizations, deaths, and vaccinations (IDcare). BMC Public Health, 26(1), Article 2980. https://doi.org/10.1186/s12889-026-29868-8

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29868-8

Keywords: COVID-19, intellectual disability, Skåne, register cohort, hospitalization, mortality, vaccination, healthcare utilization, Sweden, people, intellectual, disability