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Predictors of mortality in children with severe mental retardation: the effect of placement
D Strauss1, R K Eyman, H J Grossman
1Department of Statistics, University of California, Riverside 92521, USA.
Insights
Severely disabled children with mental retardation face higher mortality risks with reduced mobility and tube feeding. Community care may increase mortality risk compared to institutions, suggesting quality of care impacts outcomes.
Area of Science:
- Pediatric Health
- Developmental Disabilities
- Public Health Policy
Background:
- Children with severe mental retardation and fragile medical conditions are a vulnerable population.
- Understanding mortality predictors is crucial for improving care and outcomes.
- Deinstitutionalization trends necessitate examination of care setting impacts.
Purpose of the Study:
- To identify predictors of mortality in severely disabled children with mental retardation.
- To compare risk-adjusted mortality rates between institutional and community-based care settings.
Main Methods:
- Analysis of 24,469 person-years from California developmental services registry.
- Inclusion of children with severe mental retardation and fragile medical conditions.
- Statistical assessment of variables including mobility, tube feeding, and adaptive skills.
Main Results:
- Reduced mobility and tube feeding significantly increased mortality risk.
- Community care settings (own home, community facilities) showed a 25% higher risk-adjusted mortality odds than institutions.
- Risk-adjusted mortality rates were higher in community settings.
Conclusions:
- Differential mortality rates suggest a potential impact of care quality across settings.
- The trend toward deinstitutionalization may be associated with increased mortality for this population.
- Further research into quality of care in community settings is warranted.
Objectives:
This study was undertaken to assess the predictors of mortality in severely disabled children with mental retardation, and to compare risk-adjusted mortality rates for those living in institutions with rates for those living in the community.
Methods:
Statistical analysis was performed on a set of 24,469 person-years, derived from a population of all children with severe mental retardation and a fragile medical condition who are registered with the California Department of Developmental Services. Variables included age, several measures of mobility, the presence or absence of tube feeding, the level of retardation, and certain adaptive skills.
Results:
Reduced mobility and the use of tube feeding were associated with a large increase in mortality risk. Own home residence and community care facilities have an estimated 25% higher risk-adjusted odds on mortality than institutions and health facilities.
Conclusions:
The differential mortality in the placements points to a possible effect of quality of care. One consequence of the current trend toward deinstitutionalization may be an increased mortality rate in children with severe developmental disability.