Written Denise Baez
People with Down syndrome have a 4-fold increased risk for hospitalisation from coronavirus disease 2019 (COVID-19) and a 10-fold increased risk for COVID-19-related death, according to a study published in the Annals of Internal Medicine.
Down syndrome is not on the UK shielding list or on the US Centers for Disease Control and Prevention list of groups at “increased risk,” noted Julia Hippisley-Cox, MD, University of Oxford, Oxford, United Kingdom, and colleagues.
“However, [Down syndrome] is associated with immune dysfunction, congenital heart disease, and pulmonary pathology and, given its prevalence, may be a relevant albeit unconfirmed risk factor for severe COVID-19,” the authors wrote. “We are unaware of the effects of Down syndrome on COVID-19 outcomes being reported elsewhere yet during this pandemic.”
For the study, the researchers used QResearch, a population-level primary care database that has collected data for more than 35 million persons in England since 1998 and is linked at the individual patient level to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing results from Public Health England, hospital episode statistics, and the Office of National Statistics death registry.
A total of 4,053 people with Down syndrome were identified, of which 27 died from COVID-19 between January 24, 2020, and June 30, 2020. Of the 8,252,105 persons without Down syndrome, 8,457 died of COVID-19.
After adjusting for age and sex, the hazard ratio (HR) for COVID-19-related death in adults with Down syndrome versus without Down syndrome was 24.94 (95% confidence interval [CI], 17.08-36.44). After adjustment for age, sex, ethnicity, BMI, dementia diagnosis, care home residency, congenital heart disease, and a range of other comorbid conditions and treatments, the HR for COVID-19-related death was 10.39 (95% CI, 7.08-15.23). For hospitalisation, the HR was 4.94 (95% CI, 3.63-6.73).
“This was after adjustment for cardiovascular and pulmonary diseases and care home residence, which our results suggest explained some but not all of the increased risk,” the authors wrote. “These estimated adjusted associations do not have a direct causal interpretation because some adjusted variables may lie on causal pathways, but they can inform policy and motivate further investigation.”