Risk factors and outcomes of COVID-19 in individuals with Down syndrome

Date of ISAC Approval: 
18/06/2020
Lay Summary: 
People with Down syndrome (DS), caused by trisomy 21, have many co-occurring conditions beyond intellectual disability, that may increase their risk for COVID-19 or its progression. For example, their immune system compromises their ability to fight respiratory infections. This might also be true for viral infections, but there is no literature that addresses this question. Our study proposes to establish if people with DS are affected more commonly than their peers from the general population or with Intellectual disabilities with viral respiratory infections and /or COVID-19 diagnoses during the COVID-19 pandemic, and to identify specific risk factors based on co-occurring conditions for infections and poor outcomes, as well as to determine whether disease progression is associated with these pre-existing conditions. We will also study whether they experience different access to different treatments, and if response to treatments differ in individuals with Down syndrome. By studying people with Down Syndrome, a condition with genetic risk for particular health conditions including viral infections such as COVID-19, we can inform strategies and interventions to help improve outcomes in these individuals such as whether “sheltering” is advisable during such pandemics, and if there are inequalities in care that need to be addressed.
Technical Summary: 
Our overarching hypothesis is that DS individuals may be more vulnerable to developing COVID-19 which is not solely explained by co-occurrence of intellectual disability, and that they may also have worse outcomes following infection. Objectives: We will include individuals with Down syndrome in the CPRD datasets (GOLD, and Aurum) and 1) define their typical seasonal incidence for influenza/ flu and respiratory infection diagnosis and cause-specific as well as all-cause mortality rates to generate expected rates, 2) describe excess flu-like and respiratory infections and mortality as well as suspected, clinically-diagnosed or confirmed COVID-19 diagnoses during the COVID-19 pandemic in comparison with their peers with intellectual disabilities and general population, 3) explore and compare factors associated with excess infections during the COVID-19 pandemic, and 4) compare the treatment/ interventions offered and associated outcomes (e.g. hospitalisation/ death/ discharge/ recovery) and factors associated with poor outcome for those diagnosed with COVID-19. Methods: We will select a cohort of individuals with DS from CPRD and conduct an interrupted time series analysis, of individuals with Down syndrome compared to individuals from the general population, and those who have intellectual disabilities but not Down syndrome, to explore influenza/ seasonal flu, respiratory infection and COVID-19 diagnoses as well as mortality.
Health Outcomes to be Measured: 
Flu-like illness/ influenza, respiratory infections, COVID-19 suspected or confirmed diagnosis, cause-specific and all-cause mortality rates
Collaborators: 

Andre Strydom - Chief Investigator - King’s College London
Asaad Baksh - Collaborator - King’s College London
Martin Gulliford - Corresponding Applicant - King’s College London

Linkages: 
HES Admitted;ONS;Patient IMD;Practice IMD (Standard)