Hospitalisations and deaths due to Ambulatory Care Sensitive Conditions (ACSC) among adults with and without Intellectual Disabilities in Scotland

Background Conditions that should be sufficiently managed in primary health care are collectively known as Ambulatory Care Sensitive Conditions (ACSC). The rate of unplanned hospital admissions for ACSC can be regarded as a proxy indicator of how well the primary care system works for a population of interest. We investigate such rates in Scotland, focusing on adults with Intellectual Disabilities (ID) and contrasting them with adults without ID. Method A population-based retrospective cohort data linkage study of adult respondents to Scotland’s 2011 Census. Self- or proxy-reported ID status from the Census was linked to hospital admissions data and deaths data. The cohort was followed until the end of 2019. Results After adjusting for different ACSC prevalence in ID and non-ID cohorts, we did not find evidence of there being a higher risk of unplanned ACSC hospitalisation among people with ID. COPD, seizures and epilepsy, influenza and pneumonia were responsible for half of ACSC hospitalisations, regardless of ID status. However, adults with ID had a higher risk of dying due to ACSC than adults without ID. Conclusions We conclude that overall, the primary care system in Scotland appears to be similarly effective for adults with ID than for adults without ID. However, the higher risk of dying from ACSC among people with ID needs further research. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study was funded by the Scottish Government via the Scottish Learning Disabilities Observatory (SLDO). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The research was approved by Scotland's Public Benefit and Privacy Panel for Health (1819-0051), Scotland's Statistics Public Benefit and Privacy Panel (1819-0051), and the University of Glasgow's College of Medical, Veterinary, and Life Sciences Ethical Committee (200180081). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data used in this study were available in the Scottish National Safe Haven (Project Number: 1819-0051), but as restrictions apply, they are not publicly available. Access to data may be granted on application to, and subject to approval by, the Public Benefit and Privacy Panel for Health and Social Care. Applications are coordinated by eDRIS (electronic Data Research and Innovation Service). The anonymised data used in this study was made available to accredited researchers only through the Public Health Scotland (PHS) eDRIS User agreement.