American Journal of Epidemiology Vol. 147, No. 9: 855-862
Copyright © 1998 by The Johns Hopkins University School of Hygiene and Public Health
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External Causes of Death among Persons with Developmental Disability: The Effect of Residential Placement
1 Department of Statistics, University of California Riverside, CA
2 Department of Health Care and Epidemiology; Faculty of Medicine, University of British Columbia Vancouver, British Columbia, Canada
3 The Kennedy Center, Vanderbilt University, Nashville, TN. Reprint requests to Dr. David Strauss, Department of Statistics, University of California Riverside, CA 92521–0138
Reprint requests to Dr. David Strauss, Department of Statistics, University of California, Riverside, CA 92521-0138.
The authors analyzed death rates from external causes (accidents, injuries, homicides, etc.) for persons with developmental disability in California. There were 520 such deaths during the 1981–1995 study period, based on 733,705 person-years of exposure; this represents all persons who received any services from the state. Compared with the general California population, persons with developmental disability were at lower risk of homicide, suicide, and poisonings (standardized mortality ratios, 0.31–0.68), but higher risk of pedestrian accidents, falls, fires, and, especially, drowning (standardized mortality ratio = 6.22). A major focus of the study was comparisons between different residential settings. Persons in semi-independent living had significantly higher risk than did those in their family home or group homes, with homicides rates being three times higher and pedestrian accidents rates being doubled, while persons in institutions had much lower risks with respect to most causes. Of the 28 deaths due to drug and medication overdoses, 79 percent occurred in supported living or small-group homes. Avoidable deaths could be reduced by making direct care staff more aware of the risks and better trained in acute care, along with improved monitoring of special incidents. Am J Epidemiol 1998;147:855-62.
death rate; group homes; mental retardation; residential facilities
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