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Avoidable mortality for people with disabilities: a systematic review and meta-analysis
Sara Rotenberg1, Yi Yang2, Maureen Moyo-Chilufya3
1International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Objectives:
To estimate the proportion and relative inequalities in avoidable mortality for people with disabilities globally.
Design:
Systematic review and meta-analysis of population-based studies.
Data Sources:
A systematic search of Embase, MEDLINE, Global Health and PsycINFO was conducted for articles on disability and mortality published from January 2000 to July 2026.
Eligibility Criteria:
We included studies that reported on avoidable, treatable and preventable mortality and disability. Eligible studies were quantitative studies that provided a numeric proportion of avoidable mortality and/or relative measures compared with people without disabilities.
Results:
Our search identified 1250 deduplicated records that were assessed for eligibility and 12 articles representing 15 unique cohorts were included in the study. All the data were from high-income countries and examined avoidable mortality for people with intellectual and developmental disabilities. Most were low risk of bias (75%) and the rest were medium (25%), as measured by the JBI Quality Appraisal Tool for Cohort Studies. Avoidable mortality was reported overall and for treatable and preventable sub-indicators. Results had high heterogeneity, but found people with disabilities had 45% (95% CI 45% to 46%) of deaths deemed avoidable, 22% (95% CI 21% to 22%) treatable and 21% (95% CI 20% to 21%) preventable. This represented significant relative inequalities for 3.60 (95% CI 3.53 to 3.68) times higher avoidable mortality; 5.82 (95% CI 5.64 to 6.01) times higher treatable mortality and 2.58 (95% CI 2.50 to 2.66) times higher preventable mortality compared with people without disabilities.
Conclusions:
A substantial proportion of early mortality for people with disabilities is likely to be avoidable. Some of this may be due to underlying impairments, but these inequalities are unlikely due to impairment alone. Rather, they reflect significant health inequalities that contribute to differences in life expectancy compared with people without disabilities, though all data are from high-income countries. Health systems must adapt to improve accessibility and quality of care for this population.
Prospero Registration Number:
CRD420251072430.