Coronavirus (COVID-19) - disabled people: health, social and economic harms - research report

Executive Summary

This report uses demographic data and data on deaths involving COVID-19^[1] to assess whether COVID-19 mortality rates for disabled people in Scotland are similar to rates in England and Wales. Mortality rates are a way of measuring the number of deaths (in this case involving COVID-19) in a particular population, scaled to the size of that population.

Provisional analysis from the Office for National Statistics (ONS), published in September 2020^[2], demonstrated that the relative differences in COVID-19 mortality rates between those disabled and limited a lot and those non-disabled^[3] were 2.4 times higher for women and 2.0 times higher for men^[4] in England and Wales.

Age-standardisation allows populations with different age profiles to be compared. This is particularly important when considering mortality rates for disabled people because disability is more common amongst older people. When ONS considered the age-standardised mortality rates (ASMRs) for deaths involving COVID-19 in England and Wales they found that that mortality rates were higher for disabled people across all age groups, but the relative gaps in ASMRs between disabled and non-disabled men and women were largest amongst those aged 9 to 64 years. Relative gaps in ASMRs between non-disabled and disabled groups were smaller in the 65 years and over age group.

The largest relative gap in ASMRs was between women aged 9 to 64 years who were disabled and limited a lot, who had a rate of death involving COVID-19 10.8 times greater than non-disabled women in this age group. Men aged 9 to 64 years who were disabled and limited a lot had a rate of death involving COVID-19 6.5 times greater than non-disabled men.

The National Records of Scotland (NRS) will publish COVID-19 mortality rates for disabled people in March 2021. Despite differences in the policy context, it is expected that the NRS findings will be broadly similar to the English and Welsh results on COVID-19 mortality rates for disabled people published in September 2020, for the following reasons:

• Demographics of the disabled population are broadly similar – in all three countries 1 in 5 people were disabled according to the 2011 Census.
• Prevalence of long-term conditions in Scotland, England and Wales are similar - in all 3 countries the most common conditions were 'musculoskeletal system' (which includes conditions such as arthritis and back problems), followed by 'heart and circulatory illnesses', and 'mental disorders'. 'Ischaemic heart diseases', which are included within the 'heart and circulatory illnesses', are linked to increased COVID-19 deaths.^[5]
• The demographic profile of deaths involving COVID-19 is similar in England, Wales and Scotland. People whose deaths involved COVID-19 were:

- more likely to be aged 75+;

- more likely to be a man;

- more likely to experience multiple deprivation;

- more likely to have a pre-existing medical condition.

• Frequency of types of pre-existing health conditions in deaths involving COVID-19 are similar for older people:

- In England and Wales, and also Scotland, the most common pre-existing medical condition in deaths involving COVID-19 for women aged 65+ was 'dementia and Alzheimer's disease' (34% in England and Wales vs. 38% in Scotland). This is followed by 'chronic respiratory diseases' (8% in England and Wales vs. 12% in Scotland).

- There were similar rates of 'ischaemic heart diseases' (5% in England and Wales vs 8% in Scotland) and 'cerebrovascular disease' (4% in England and Wales vs. 6% in Scotland).

- The most common main pre-existing conditions amongst men aged 65+ in deaths involving COVID-19 in England and Wales and Scotland was 'dementia and Alzheimer's disease' (24% in England and Wales vs. 24% in Scotland), followed by 'ischaemic heart diseases' (15% in England and Wales vs. 21% in Scotland).

- Rates of 'chronic lower respiratory diseases' were similar for men aged 65+ (8% in England and Wales vs. 9% in Scotland).

It is important to note that there were differences in the types of pre-existing health conditions in deaths involving COVID-19 for people aged below 65.^[6] Women in Scotland whose deaths have involved COVID-19 were more likely to have the pre-existing conditions of 'ischaemic heart diseases' and 'chronic lower respiratory diseases' than women aged under 65 in England and Wales, and both men and women were more likely to have pre-existing conditions of 'diabetes' and 'cirrhosis and other disease of the liver' than people aged under 65 in England and Wales. These patterns may be due to differences in underlying population health.

COVID-19 mortality rates and people with learning/intellectual disabilities

This report also summarises findings on mortality rates for deaths involving COVID-19 amongst people with learning/intellectual disabilities. Research from The Scottish Learning Disabilities Observatory (SLDO)^[7] has demonstrated that:

• People in the learning/intellectual disabilities population were more than 3 times more likely to die from COVID-19 than those in the general population.
• People with learning/intellectual disabilities were twice as likely as those in the general population to become infected with COVID-19.
• People with learning/intellectual disabilities were twice as likely to experience a severe outcome of COVID-19 infection, resulting in hospitalisation and/or death.

Wider impacts of COVID-19 on disabled people

This report also summaries evidence from a range of disabled people's organisations. This evidence indicates that, alongside experiencing direct COVID-19 health impacts, disabled people are also experiencing a range of other harms:

• Disruption of routine health and social care due to the pandemic has had a disproportionately negative impact on disabled people, who are more likely to require such services.
• Disabled people, who were already more likely to be experiencing mental health problems prior to the pandemic, have experienced increased mental ill-health as a result of the pandemic.
• There are a number of accessibility issues for disabled people using public transport, shopping and eating out as a result of busier streets, one way systems, potential queuing and the requirement to physically distance.
• Disabled people, who were already more likely than non-disabled people to experience loneliness, have faced increased isolation as a result of the COVID-19 pandemic.
• There is evidence that disabled people, who are more likely to experience poverty, and more likely to work in sectors which have been hit hard by COVID-19, or not be employment, are facing increased debt and economic difficulties as a result of the COVID-19 pandemic.
• Disabled people have experienced issues with accessing food as a result of food shortages, gaps and delays in receiving shielding support and priority deliveries.