Are people with disabilities at higher risk of COVID-19-related mortality?: A systematic review and meta-analysis

OBJECTIVES: To undertake a systematic review and meta-analysis to estimate the relative risk of COVID-19-related mortality among people with disabilities compared to people without disabilities. STUDY DESIGN: Systematic review and meta-analysis. METHODS: . We systematically searched four databases from March 1 2020 to August 15th, 2022. We included prospective studies with a baseline assessment of disability and longitudinal assessment of the COVID-19 related mortality. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. We undertook random-effects meta-analyses to calculate pooled adjusted hazard ratios for COVID-19 related mortality for people with disabilities, also disaggregated by disability type and study setting. RESULTS: We identified 2,596 articles throughout electronic data search, and 56 studies were included in the review. Most (73%) had a moderate risk of bias. The pooled adjusted effect estimate for COVID-19 related mortality in people with disabilities compared to those without was 2.7 (95% CI 2.4-3.2). Heterogeneity between the studies was high (τ(2)=0·28, I(2)=97%). Effect estimates were highest for population-based samples (3.3, 95% CI 2.7 – 3.9), compared to hospital settings (2.1, 95% CI 1.7 – 2.7). Risk was not elevated among people with disabilities in care home settings (1.6, 95% CI 0.7 – 3.5). Disaggregation by disability type showed that people with intellectual disabilities were at highest relative risk of COVID-19 mortality. DISCUSSION: Risk of COVID-19 mortality is elevated among people with disabilities, especially people with intellectual disabilities. Efforts are needed to collect better routine data on disability, and to include people with disabilities in the pandemic response for COVID-19.