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Abstract：
People with intellectual disabilities experience overall poorer health and healthcare access than the general population. It is largely unknown how this applies to asthma and chronic obstructive pulmonary disease (COPD) management by general practitioners (GPs). In a 10-year retrospective matched cohort study, n = 34,429, we examined year prevalence of asthma and COPD in adult patients with and without intellectual disabilities and potential differences in the delivery of asthma and COPD disease management activities in Dutch general practices (2010-2019). We collected information on patient characteristics, comorbidity, consultation patterns, use and outcomes of asthma/COPD control questionnaires, spirometry measurement, pulmonology referrals, and prescribed medication. Asthma patients with intellectual disabilities suffered more frequently from obesity (53.2% vs. 39.5% without intellectual disabilities), and both asthma and COPD patients with intellectual disabilities were more frequently current smokers (45.2% vs. 22.1% without intellectual disabilities, and 76.6% vs. 51.4% without intellectual disabilities, respectively). Also, a statistically significant larger number of asthma patients with intellectual disabilities were prescribed antibiotics (69.9% vs. 54.5%). COPD patients with intellectual disabilities, compared with matched controls without intellectual disabilities, received significantly more often either no COPD-related practice consultation at all (respectively 20.8% vs. 8.5%, p = 0.004) or a large number of practice consultations (>31 consultations, respectively 16.7% vs. 5.3%, p = 0.004). For asthma, there was no statistical difference between patients with or without intellectual disabilities regarding the number and type of consultations. The asthma year point prevalence in patients with intellectual disabilities was, from 2014 onward, significantly higher, and in 2019 was 8.7% vs. 6.0% for people without intellectual disabilities. For COPD, it was comparable in both groups. Both asthma and COPD patients with intellectual disabilities appeared considerably younger in age than patients without intellectual disabilities. Our findings warrant further research into the causes of the differences found for asthma and COPD and whether they also infer differences in the quality or the effectiveness of GP disease management, especially for young adults with intellectual disabilities.
摘要：
与一般人群相比，智障人士的健康状况和医疗保健机会总体较差。尚不清楚这如何适用于全科医生（GP）的哮喘和慢性阻塞性肺疾病（COPD）管理。在一项为期10年的回顾性配对队列研究中，n=34,429，我们检查了有和没有智力残疾的成年患者中哮喘和COPD的年患病率，以及荷兰一般实践中哮喘和COPD疾病管理活动的潜在差异（2010-2019）。我们收集了有关患者特征的信息，合并症，协商模式,哮喘/COPD控制问卷的使用和结果，肺活量测定,肺科转诊,和处方药。患有智力障碍的哮喘患者更容易患肥胖症（53.2%vs.39.5%无智力障碍)，患有智力障碍的哮喘和COPD患者目前吸烟的频率更高(45.2%vs.22.1%无智力障碍，和76.6%vs.51.4%没有智力障碍，分别)。此外，有统计学意义的更多有智力障碍的哮喘患者服用抗生素(69.9%vs.54.5%）。患有智力障碍的COPD患者，与没有智力障碍的配对对照相比，接受COPD相关实践咨询的频率明显更高(分别为20.8%与8.5%,p=0.004)或大量的实践咨询(>31次咨询，分别为16.7%与5.3%,p=0.004)。对于哮喘，有或没有智力障碍的患者在咨询次数和类型方面没有统计学差异.智力障碍患者的哮喘年患病率为，从2014年起,明显更高,2019年为8.7%，而不是无智障人士占6.0%。对于COPD，两组具有可比性。患有智力障碍的哮喘和COPD患者的年龄均比没有智力障碍的患者年轻得多。我们的发现值得进一步研究哮喘和COPD差异的原因，以及它们是否也推断GP疾病管理的质量或有效性的差异。特别是对于有智力障碍的年轻人。
