Health risks, service use and outcomes of people with disability

Why did we do the review?

People with disability often die younger than people without disability. Research shows that preventable factors contribute to some of these deaths. Understanding what types of health risks or health problems people with disability are more likely to experience can help us understand how to prevent serious health problems and avoidable deaths.

We did this review to understand what these health risks and problems are. To do this, we looked for research studies reporting data on the health risks people with disability face, how they use health services, their health outcomes, and the main reasons for their deaths.

We included studies from many countries and sources such as health and disability services, national registries, hospital records, caregiver surveys, and linked datasets.

We used a method called meta-analysis to combine data from different studies to find patterns and relationships.

How we did the review

Our researchers searched for studies published from 2000 to 2023 reporting the rates of health risks, health service use, health outcomes and causes of death in people with disabilities compared to the general population.

We searched research databases to find good-quality studies that focus on the following types of disability:

• Traumatic brain injury
• Autism spectrum disorder
• Intellectual disability.

Our findings

We found 68 studies from 12 countries. These studies showed that people with traumatic brain injury, autism spectrum disorder, and intellectual disability experience significantly poorer health outcomes and increased risk of death compared to the general population. 

There was strong evidence from 3 or more large-scale studies that people with traumatic brain injury are more likely to have multiple health problems, including those related to the heart and blood vessels, hormone and digestive systems, and mental health, and a greater risk of dying from self-harm compared to the general community.

There was also strong evidence that people with autism spectrum disorder are more likely to be at risk of obesity and diabetes compared to the general community. They are also more likely to visit emergency departments (EDs) or be hospitalised, and die from causes such as accidents, injuries and suicide. People with autism spectrum disorder are also more likely to have poor health affecting the digestive, mental and nervous systems.

As with people with autism spectrum disorder, there was strong evidence that people with intellectual disability are more likely to be at risk of obesity and diabetes compared to the general community. People with intellectual disability are also more likely to visit EDs and more likely to die from a range of causes compared to the general community. People with intellectual disability are also at increased risk of poor health affecting the urinary and respiratory systems.

The following diagram shows the increased risk of poor health outcomes (as a percentage) in people with acute brain injury, autism spectrum disorder and intellectual disability compared to the general community.

People with traumatic brain injuries

Risk level is compared to the general community.

Health risks

• Cardiovascular
  54% higher risk
  (Tobacco smoking)

Health outcomes

• Cardiovascular
  90% higher risk
• Endocrine
  49% higher risk
  (Diabetes)
• Gastrointestinal
  27% higher risk
• Mental
  118% higher risk
  (Depression, substance abuse)

Cause of death

• Self-harm
  182% higher risk

People with autism spectrum disorder

Risk level is compared to the general community.

Health risks

• Metabolic
  102% higher risk
  (Obesity)

Health outcomes

• Endocrine
  138% higher risk
  (Diabetes)
• Gastrointestinal
  20% higher risk
• Mental
  133% higher risk
  (Schizophrenia or other psychotic, Anxiety)
• Neurological
  573% higher risk
  (Epilepsy)

Service use

• ED visits
  61% higher risk
• Hospitalisation
  245% higher risk

Cause of death

• Premature mortality
  122% higher risk
• Accident or injury
  422% higher risk
• Suicide
  210% higher risk

People with intellectual disability

Risk level is compared to the general community.

Health risks

• Metabolic
  74% higher risk
  (Obesity)

Health outcomes

• Endocrine
  56% higher risk
  (Diabetes)
• Urinary
  151% higher risk
• Respiratory
  66% higher risk
  (Asthma)

Service use

• ED visits
  61% higher risk

Cause of death

• Gastrointestinal
  66% higher risk
• Endocrine
  54% higher risk
• Infection
  112% higher risk
  (Infection or parasitic)
• Urinary
  137% higher risk
• Mental
  112% higher risk
• Neurological
  256% higher risk
  (Nervous system)
• Respiratory
  154% higher risk

What do the findings mean?

The findings are consistent with earlier reports on predictors of deaths among people with disability but provides much more detailed information on health risks, health service use, health outcomes and causes of death in people with traumatic brain injury, autism spectrum disorder and intellectual disability.

Some studies made recommendations on how to reduce these risks, such as training staff, regular check-ups, early screening, tracking health problems, quick action, and care that suits each person.

Our results show we need better and more targeted health policies. These should:

• focus on prevention
• support inclusive and fair healthcare.

A clear plan based on evidence can improve health, give fair care, and help people with these disabilities live healthier, longer lives.