Download PDFPDF

Original research
Rates, causes, place and predictors of mortality in adults with intellectual disabilities with and without Down syndrome: cohort study with record linkage
Compose Response

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g.
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests


  • A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
  • We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
  • Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
  • By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

Jump to comment:

  • Published on:
    Rates, causes, place and predictors of mortality in adults with intellectual disabilities with and without Down syndrome: cohort study with record linkage
    • Sally-Ann Cooper, Professor of Learning Disabilities Institute of Health and Wellbeing, University of Glagow
    • Other Contributors:
      • Linda Allan, Clinical Associate Professor - Learning Disabilities
      • Nicola Greenlaw, Consultant Biostatistician
      • Paula McSkimming, Trainee Biostatistician
      • Adam Jasilek, Trainee Biostatistician
      • Angela Henderson, Deputy Director - Scottish Learning Disabilities Observatory
      • Colin McCowan, Professor in Health Data Science
      • Deborah Kinnear, Senior Lecturer of Intellectual Disabilities
      • Craig Melville, Professor of Intellectual Disabilities Psychiatry

    We thank Professor Kawada for his interest in our study.(1) We agree that the three recent papers he quotes are interesting studies that make important contributions. We do not agree with his expression of concerns about our study as they seem to reflect an assumption that different reporting to the papers he quoted were the concerns; these studies are not comparable to ours.

    Oppewal et al. studied only elderly people,(2) whilst our study was of adults aged 16 years and over; their study included people using three care providers, whilst ours was population based. Oppewal et al. gathered cause of death information from medical case-files, and acknowledged, amongst other limitations, that information on cause of death in these files was sometimes limited which was beyond their control. Indeed they reported immediate and primary (underlying) cause of death, but not contributing causes of death, raising the question of whether it was possible for them to distinguish underlying and contributing causes of death from the case-files. We found the most common underlying causes of death for the adults with Down syndrome were dementia (35.1%), then other infection (12.3%); but when considering all contributing causes of death (not just the underlying cause), we found the most common after Down syndrome to be dementia (42.1%), and respiratory infection (38.6%) (reported in our table 5).

    In a study published in the same month as ours, De Campos Gomes et al. reported hig...

    Show More
    Conflict of Interest:
    None declared.
  • Published on:
    RE: Rates, causes, place and predictors of mortality in adults with intellectual disabilities with and without Down syndrome

    Cooper et al. investigated clinical predictors of mortality in adults with intellectual disabilities (1). Standardized mortality ratios (SMRs) (95% confidence interval [CI]) in Down syndrome adults and adults without Down syndrome were 5.28 (3.98, 6.57) and 1.93 (1.68, 2.18), respectively. In addition, SMRs in males and females were 1.69 (1.42, 1.95) and 3.48 (2.90, 4.06), respectively. Aspiration/reflux/choking and respiratory infection were the most common causes of mortality in adults without Down syndrome, and dementia was the most common causes of mortality in Down syndrome adults. Mortality risk related to percutaneous endoscopic gastrostomy/tube fed, Down syndrome, diabetes, lower respiratory tract infection at cohort-entry, smoking, epilepsy, hearing impairment, increasing number of prescribed drugs, increasing age were related to mortality in adults with intellectual disabilities. I have some concerns about their study.

    First, Oppewal et al. also reported the cause-specific mortality of older Down syndrome adults with intellectual disability (2). The common cause of mortality was respiratory disease (51.1%), followed by dementia (22.2%), and this information was not consistent with data by Cooper et al. Methodological difference of survey, including definition, might contribute to the statistical information.

    Second, de Campos Gomes et al. analyzed mortality and related factors in individuals with Down syndrome in Brazil (3). They concluded that ethn...

    Show More
    Conflict of Interest:
    None declared.