Increased mortality in children and adolescents with developmental disabilities

A population-based cohort of 10-year-old children with mental retardation, cerebral palsy, epilepsy, hearing impairment or vision impairment, who were ascertained at 10 years of age in a previous study conducted in metro Atlanta during 1985-87, was followed up for mortality and cause of death information. We used the National Death Index to identify all deaths among cohort members during the follow-up period (1985-95). We estimated expected numbers of deaths on the basis of actual age-, race- and sex-specific death rates for the entire Georgia population for 1989-91. The objective was to quantify the magnitude of increased mortality and evaluate the contribution of specific disabilities to mortality among children and adolescents with one or more of five developmental disabilities. A total of 30 deaths were observed; 10.1 deaths were expected, yielding an observed-to-expected mortality ratio of almost three to one. The numbers of observed deaths exceeded those of expected deaths, regardless of the number of disabilities present, but the ratios were statistically significant (at the 95% confidence level) only in children with three or more co-existing disabilities. In general, the magnitude of the mortality ratios was directly related to various measures of the severity of the person's disability. An exception to this pattern was the elevated mortality from cardiovascular disease among cohort members with isolated mental retardation (three observed deaths vs. 0.2 expected). The specific underlying causes of death among other deceased cohort members included some that were the putative cause of the developmental disability (e.g. a genetic syndrome) and others that could be considered intercurrent diseases or secondary health conditions (e.g. asthma). Prevention efforts to decrease mortality in adolescents and young adults with developmental disabilities may need to address serious conditions that are secondary to the underlying disability (i.e. infections, asthma, seizures) rather than towards injuries, accidents and poisonings, the primary causes of death for persons in this age group in the general population.