Morbidity and medication in a large population of individuals with Down syndrome compared to the general population

TLDR

The study aimed to describe the incidence of morbidities and the prevalence of medical prescriptions in a large Down syndrome population. Using the UK Clinical Practice Research Datalink, a retrospective cohort of 6,430 Down syndrome individuals was matched to 19,176 controls by practice site, sex, birth year, and recording period. Children and adults with Down syndrome exhibit markedly higher rates of cardiovascular, gastrointestinal, sleep, congenital heart, ear, eye, autism, hypothyroidism, diabetes, obesity, epilepsy, intellectual disability, hypotension, and dementia, with incidence ratios ranging from 1.3 to 158, while rates of hypertension, depression, and anxiety are lower, illustrating a lifetime morbidity profile that shifts across development.

Abstract

The aim of this study was to describe the incidence of morbidities and the prevalence of medical prescriptions in a large Down syndrome population.A retrospective cohort study was carried out using the UK Clinical Practice Research Datalink from 1 January 2004 to 31 December 2013. We matched individuals with Down syndrome to randomly selected control participants by practice site, sex, birth year, and recording period.A total of 6430 individuals with Down syndrome (3009 females, 3421 males) and 19 176 controls (8966 females, 10,210 males) were included in the study. The incidence of cardiovascular disorders, gastrointestinal diseases (incidence rate ratio [IRR] 7.9 at 3 to <6y: yearly prevalence ratio [YPR] for laxatives 4.7), and sleeping disorders (IRR 4.8 in 3 to <6y) was increased in children with Down syndrome versus control participants. New onset of congenital heart malformation, ear diseases, eye disorders, autism, hypothyroidism, diabetes, and obesity were more frequent in childhood and remained elevated in adulthood (overall IRR 35.5, 1.7, 3.1, 4.4, 13.1, 1.3, and 2.6 respectively), whereas the gap widened in adulthood for epilepsy and intellectual disability (IRR 15.2 and 158 respectively, in participants older than 30y). At ≥ 30 years, the incidence of hypotension and dementia was raised (IRR 3.0 and 92.1 respectively; YPR for dementia drugs: 76.3); and that of hypertension, depression and anxiety was lowered (IRR 0.2, 0.5, and 0.4 respectively).The profile of newly occurring morbidities in Down syndrome varies across the developmental lifespan.