Hospitalisations from birth to 5 years in a population cohort of Western Australian children with intellectual disability

Abstract

Aims: To describe the hospitalisation history in the first five years of life for all children born in Western Australia (WA) between 1983 and 1992 and diagnosed with intellectual disability (ID). Methods: Unit record linkage of the WA Midwives Collection, WA Intellectual Disability Database, and the WA Hospital Morbidity Dataset provided the population database of WA born children with and without ID. Affected children were divided into those co-affected with autism spectrum disorders (ASD), and those whose ID had or had no known biomedical cause. Those without a biomedical cause were further subdivided into mild-moderate and severe categories. Results: On average, ID affected children were more likely than non-affected children to be admitted to hospital (RR: 1.64; 95% CI 1.6 to 1.7), on more occasions (5.3 versus 2.2 admissions), for longer (29.6 versus 8.3 days), and for a larger range of clinical diagnoses. The only exception was the group of children co-diagnosed with ASD whose hospitalisation profile resembled more that of non-affected children.Conclusions: This total population study is unique because of the availability of the system of linkable population registers and administrative health databases in WA. The results indicated that this vulnerable population of children with ID has substantial medical needs. This paper points to the need for authorities to develop supportive programmes for this population especially in the current climate of de-medicalisation of ID. More research is not only needed on the welfare of the affected children but also on the impact of the substantial medical and other needs of affected children on the rest of their immediate and extended families.

Factors associated with dental admissions for children aged under 5 years in Western Australia

“…Children with ID in this study had higher rates of dental admissions, as shown previously 8. Children with BD were also more likely to have a dental admission — this does not appear to have been previously reported.…”

“…The length of stay for same-day admissions was arbitrarily set at 0.5 days 8. Unless otherwise specified, a dental admission was defined as an admission to hospital where the principal diagnosis at discharge was coded using any of the following codes from the 9th Revision of the International Classification of Diseases, Clinical Modification (ICD-9): 520.0–529.9; V41.6; V52.3; V53.4; V58.5; or V72.2 (table 1).…”

“…In Australia, dental caries was the fifth most common reason for hospital admission for 1 to 4 year olds in 1999–2000 and dental categories accounted for 7% of all procedures performed in hospital up to age 14 years 7. We have recently investigated hospital admissions in children aged under 5 years with and without intellectual disability (ID) and found that those with ID had an increased relative risk of dental admission 8. The cost of providing dental treatment for young children under general anaesthesia has been reported in the USA as US$2,009 per case9 while in WA the average cost for hospital extractions and restorations for all ages was A$2,011 per case 10…”

Linked data: Opportunities and challenges in disability research

“…In Australia, data linkage research concerning people with ID has largely occurred in WA, linking data from the WA Disability Services Commission or the IDEA database with various state-based registers such as birth defects, hospitalisations, and maternal health during pregnancy (e.g., Leonard, de Klerk, Bourke, & Bower, 2006;Petterson, Bourke, Leonard, Jacoby, & Bower, 2007;Williams et al, 2005). The IDEA database contains ongoing, population-based information on ID in WA based on medical and demographic data collected by the Disability Services Commission and supplemented with information provided by the Department of Education.…”

Primary healthcare interventions for people with intellectual disability

“…A number of studies have found high rates of hospitalisation for injuries, infections, diseases and disorders of the nervous system and respiratory system, kidney and urinary tract problems, 'mental issues', dental conditions and skin disorders (Australian Bureau of Statistics., 2011; NSW Ministry of Health, 2012;Williams, Leonard, & Tursan D'Espaignet, 2005).…”