Prevalence, Risk Factors, and Outcomes of Chronic Diseases in Adults with Intellectual Disabilities: A Scoping Review of Primary Care Evidence

Prevalence, Risk Factors, and Outcomes of Chronic Diseases in Adults with Intellectual Disabilities: A Scoping Review of Primary Care Evidence | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Prevalence, Risk Factors, and Outcomes of Chronic Diseases in Adults with Intellectual Disabilities: A Scoping Review of Primary Care Evidence Hasheem Mannan, Sahar Nasri, Aala Abtin, Maryam Kazemi, Hamidreza Rabiei-Dastjerdi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7552881/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Adults with intellectual disabilities (ID) experience higher rates of chronic diseases compared to the general population. Yet, evidence on the prevalence, risk factors, and outcomes of these conditions in primary care settings remains fragmented. This scoping review aims to map the existing literature and identify key themes related to chronic diseases among adults with ID. Methods: A comprehensive search was conducted across five electronic databases— Embase, Medline, PubMed, Web of Science, and PsycINFO —from inception to May 2024. Studies were included if they focused on the prevalence, risk factors, or outcomes of chronic diseases in adults (aged 18 or older) with intellectual disabilities and were based on primary care evidence. A total of 1,365 records were initially identified. After duplicate removal, screening, and full-text assessment, eligible studies were charted and thematically analyzed following the Arksey and O'Malley framework. Results: The included studies reported a high prevalence of chronic conditions such as ischemic heart disease, cerebrovascular disease, diabetes, and chronic obstructive pulmonary disease (COPD) among adults with ID. Risk factors included age, sedentary lifestyle, poor diet, comorbid mental health conditions, and limited access to tailored healthcare services. Outcomes often included reduced quality of life, increased hospitalizations, and premature mortality. Variation in diagnostic criteria, healthcare access, and recording practices across primary care settings posed challenges in data comparability. Conclusions: Adults with intellectual disabilities face a disproportionate burden of chronic diseases, with multifactorial risk profiles and significant adverse outcomes. Primary care systems must adopt more inclusive practices, implement early screening strategies, and provide tailored interventions to reduce health disparities in this vulnerable population. Further research is needed to strengthen the evidence base and inform policy and practice. Intellectual disabilities Chronic disease Primary care Health promotion Evidence based practice Figures Figure 1 INTRODUCTION Chronic diseases represent a significant burden on healthcare systems worldwide and are among the leading causes of disability, reduced quality of life, and premature death. Adults with intellectual disabilities (ID) are particularly vulnerable to these conditions due to a combination of biological, social, and systemic factors. The high prevalence of chronic diseases in this population underscores the importance of early identification, targeted prevention, and continuous care strategies (1). Despite growing attention to health disparities, individuals with intellectual disabilities remain underserved in many aspects of healthcare, particularly in the management and prevention of chronic diseases. These individuals often face multiple barriers, including communication difficulties, limited health literacy, and inadequate access to primary care services (2). Moreover, health data regarding adults with ID are often fragmented or underreported, leading to gaps in planning and service delivery (3). Primary care plays a critical role in the early detection and ongoing management of chronic diseases. It serves as a frontline platform for preventive interventions, patient education, and continuity of care. For adults with intellectual disabilities, accessible and inclusive primary care is essential to address both general health needs and condition-specific risks (4). In recent years, several studies have explored the prevalence of chronic diseases such as ischemic heart disease, diabetes, cerebrovascular disease, and chronic obstructive pulmonary disease in adults with ID. For example, (5) found that adults with ID are significantly more likely to develop diabetes compared to the general population. In another study, (6) highlighted the increased risk of cardiovascular diseases in this group, partly due to sedentary lifestyles and medication side effects. Similarly, (7) identified poor care coordination and limited follow-up as contributors to poor health outcomes in this population. Although there is an expanding body of literature, a comprehensive synthesis of evidence regarding the prevalence, risk factors, and outcomes of chronic diseases in adults with intellectual disabilities remains limited. To address this gap, the present study adopts a scoping review approach to map the existing evidence within the context of primary care . The findings aim to inform policymakers, healthcare professionals, and researchers in designing more effective and inclusive health interventions for adults with intellectual disabilities. Research Questions What are the social factors to include in the residential living (institutional living) of adults with intellectual disabilities? What social factors should be considered in the residential living (institutional living) of adults with intellectual disabilities? 3. What is the prevalence of chronic illness, outcomes, and prevention strategies in primary care settings? 4. What is the prevalence of chronic diseases, outcomes, and prevention strategies in primary healthcare centers? Rationale for the Review Adults with intellectual disabilities (ID) or intellectual and developmental disabilities (IDD) represent a growing population with complex health needs. Evidence increasingly shows that this group experiences a disproportionate burden of chronic diseases—including diabetes, cardiovascular disease, and chronic respiratory conditions—often at younger ages and with more severe complications compared to the general population. Despite these vulnerabilities, individuals with ID/IDD frequently encounter substantial barriers in accessing high-quality primary care, including diagnostic overshadowing, communication difficulties, limited provider training, and systemic health inequities. Previous research has tended to focus on specific conditions, narrow geographic settings, or particular subpopulations (e.g., individuals with Down syndrome or autism), often using heterogeneous definitions and outcome measures. As a result, the broader landscape of chronic disease burden, associated risk factors, and health outcomes in this population remains unclear and under-synthesized, particularly within the context of primary care. Given the global emphasis on inclusive healthcare and the critical role of primary care in early detection and long-term management of chronic conditions, a comprehensive synthesis of current evidence is urgently needed. This scoping review aims to map the existing literature on the prevalence, risk factors, outcomes, and care strategies related to chronic diseases among adults with ID/IDD, identify research gaps, and inform both clinical practice and future research and policy-making in primary care settings. METHODS This study employed a scoping review methodology to provide a comprehensive overview of the field related to chronic diseases among adults with intellectual disabilities, identify existing gaps in the literature, clarify key concepts, and offer a broad map of the types of evidence and actions relevant to this area. The review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) framework and included the following five stages: The present study aimed to answer the following research question: What are the key factors associated with the prevalence, risk factors, and outcomes of chronic diseases in adults with intellectual disabilities within the context of primary care? Systematic Literature Search: To ensure comprehensive coverage of relevant studies, a systematic search was conducted across international databases including Embase , Medline , PubMed , and Web of Science , without restrictions on publication date or language. The search aimed to identify peer-reviewed literature related to the prevalence, risk factors, and outcomes of chronic diseases in adults with intellectual disabilities within the context of primary care . The search strategy included a combination of controlled vocabulary (e.g., MeSH terms) and free-text terms using Boolean operators AND and OR . The following key terms and their synonyms were used: "Intellectual disabilities" , "Chronic diseases" , "Primary care" , "Disease prevalence" , "Health disparities" , "Ischaemic heart disease" , "Cerebrovascular disease" , "Diabetes mellitus" , "Chronic obstructive pulmonary disease" , "Risk factors" , and "Outcomes" . The search strategy was carefully designed to capture studies from the inception of each database until the search date. All retrieved records were imported into EndNote , a reference management software, for screening and removal of duplicates. In addition to the database search, the reference lists of included studies were manually screened to identify any additional relevant publications. However, no grey literature was included, as the scope of this review was limited to peer-reviewed journal articles. Study Screening and Selection The inclusion criteria comprised peer-reviewed studies in English and Persian that addressed any aspect of chronic disease prevalence, risk factors, or outcomes among adults with intellectual disabilities in primary care settings. No time restrictions were applied. Exclusion criteria included studies without accessible full-text articles or those unrelated to primary care. An initial total of 1,365 records were identified through database searches (Embase, Medline, PubMed, Web of Science, and PsycInfo). After automatic and manual de-duplication using EndNote , 1,102 unique records remained for screening. In the first screening phase, titles and abstracts were reviewed against the inclusion and exclusion criteria. As a result, 950 records were excluded due to irrelevance, and 152 studies were retained for full-text assessment. During the second screening phase, full-text articles were carefully evaluated. A total of 107 studies were excluded for reasons including a lack of alignment with the study objectives, non-relevant target populations, or the absence of a primary care context. Finally, 45 studies met the eligibility criteria and were included in the scoping review. Full texts of the included studies were thoroughly reviewed, and relevant data were extracted using a standardized data charting form. The screening process was independently performed by two reviewers. Discrepancies in study selection were resolved through discussion and consensus among all research team members. The complete study selection process, including the number of records at each stage and reasons for exclusion, is visually illustrated in Fig. 1 , based on the PRISMA-ScR flow diagram. Table 1 Database Search Strategy Database Search Strategy Embase ('intellectual disability'/exp OR 'intellectual disability' OR 'developmental disability' OR 'cognitive impairment') AND ('chronic disease'/exp OR 'chronic disease' OR 'chronic illness' OR 'disease prevalence') AND ('primary health care'/exp OR 'primary care' OR 'general practice' OR 'family practice') AND ('ischaemic heart disease'/exp OR 'cerebrovascular disease'/exp OR 'diabetes mellitus'/exp OR 'chronic obstructive pulmonary disease'/exp OR 'ischaemic heart disease' OR 'cerebrovascular disease' OR 'diabetes mellitus' OR 'chronic obstructive pulmonary disease') AND ('risk factor'/exp OR 'risk factor' OR 'health outcome'/exp OR 'health outcomes' OR 'health disparity'/exp OR 'health disparities' OR 'disease outcome'/exp OR 'disease outcomes') Medline exp Intellectual Disability/ OR "intellectual disability".mp. OR "developmental disability".mp. OR "cognitive impairment".mp. AND exp Chronic Disease/ OR "chronic disease".mp. OR "chronic illness".mp. OR "disease prevalence".mp. AND exp Primary Health Care/ OR "primary care".mp. OR "general practice".mp. OR "family practice".mp. AND exp Ischemic Heart Disease/ OR exp Cerebrovascular Disorders/ OR exp Diabetes Mellitus/ OR exp Pulmonary Disease, Chronic Obstructive/ OR "ischaemic heart disease".mp. OR "cerebrovascular disease".mp. OR "diabetes mellitus".mp. OR "chronic obstructive pulmonary disease".mp. AND exp Risk Factors/ OR "risk factors".mp. OR exp Health Status/ OR "health outcomes".mp. OR exp Health Disparities/ OR "health disparities".mp. OR exp Disease Progression/ OR "disease outcomes".mp. PubMed (("Intellectual Disability"[MeSH Terms] OR "intellectual disability"[tiab] OR "developmental disability"[tiab] OR "cognitive impairment"[tiab]) AND ("Chronic Disease"[MeSH Terms] OR "chronic disease"[tiab] OR "chronic illness"[tiab] OR "disease prevalence"[tiab]) AND ("Primary Health Care"[MeSH Terms] OR "primary care"[tiab] OR "general practice"[tiab] OR "family practice"[tiab]) AND ("Ischemic Heart Disease"[MeSH Terms] OR "Cerebrovascular Disorders"[MeSH Terms] OR "Diabetes Mellitus"[MeSH Terms] OR "Pulmonary Disease, Chronic Obstructive"[MeSH Terms] OR "ischaemic heart disease"[tiab] OR "cerebrovascular disease"[tiab] OR "diabetes mellitus"[tiab] OR "chronic obstructive pulmonary disease"[tiab]) AND ("Risk Factors"[MeSH Terms] OR "risk factors"[tiab] OR "health outcomes"[tiab] OR "health disparities"[tiab] OR "disease outcomes"[tiab])) Web of Science TS=("intellectual disability" OR "developmental disability" OR "cognitive impairment") AND TS=("chronic disease" OR "chronic illness" OR "disease prevalence") AND TS=("primary care" OR "general practice" OR "family practice") AND TS=("ischaemic heart disease" OR "cerebrovascular disease" OR "diabetes mellitus" OR "chronic obstructive pulmonary disease") AND TS=("risk factors" OR "health outcomes" OR "health disparities" OR "disease outcomes") PsycINFO exp Intellectual Disability/ OR "intellectual disability".mp. OR "developmental disability".mp. OR "cognitive impairment".mp. AND exp Chronic Disease/ OR "chronic disease".mp. OR "chronic illness".mp. OR "disease prevalence".mp. AND exp Primary Health Care/ OR "primary care".mp. OR "general practice".mp. OR "family practice".mp. AND exp Ischemic Heart Disease/ OR exp Cerebrovascular Disorders/ OR exp Diabetes Mellitus/ OR exp Chronic Obstructive Pulmonary Disease/ OR "ischaemic heart disease".mp. OR "cerebrovascular disease".mp. OR "diabetes mellitus".mp. OR "chronic obstructive pulmonary disease".mp. AND exp Risk Factors/ OR "risk factors".mp. OR exp Health Outcomes/ OR "health outcomes".mp. OR exp Health Disparities/ OR "health disparities".mp. OR exp Disease Progression/ OR "disease outcomes".mp. Data Extraction and Analysis In this stage, bibliographic and content-related data were extracted from the included studies and recorded in a structured data charting table. The table encompassed key elements such as the authors’ names, year of publication, country or region of study, research objectives, study type and methodology, target population, and key findings relevant to the prevalence, risk factors, and outcomes of chronic diseases among adults with intellectual disabilities in primary care settings. Presentation of Results and Discussion Qualitative data analysis was conducted using a thematic analysis approach, following the techniques proposed by Ryan and Bernard. The research team systematically reviewed lexical patterns, recurring phrases, explicit and implicit keywords, and compared underlying assumptions and concepts across the studies to identify central themes. The process involved iterative coding, categorization, and thematic extraction to ensure rigorous data management and traceability throughout the analysis. Regular meetings were held among the research team members to validate codes and themes, ensuring consistency and credibility. Thematic interpretation was informed by relevant theoretical frameworks, facilitating a deeper understanding of the data. Based on the findings, the study provides practical recommendations aimed at improving the understanding and management of chronic diseases among adults with intellectual disabilities in primary care, while highlighting existing gaps and opportunities for future research and policy development. RESULTS The findings of this scoping review are synthesized and presented under three overarching themes: Prevalence of Chronic Diseases , Health Outcomes and Gaps in Care , and Strategies for Prevention and Management in Primary Care Settings . These themes provide a comprehensive understanding of the current landscape of chronic disease burden in adults with intellectual disabilities (ID) or intellectual and developmental disabilities (IDD). Table 2: Study Characteristics and Data Extraction Table Author & Year Title Method Country Findings 1 William F. Sullivan, et al (2018) Primary care of adults with intellectual and developmental disabilities multi-source, consensus-based approach Canada Its outcome is a robust, multi-dimensional framework for improving primary care for adults with intellectual and developmental disabilities in Canada. It addresses gaps from the 2011 guidelines and incorporates current evidence, expert experience, and stakeholder needs(8) 2 The Global Down Syndrome Foundation (GLOBAL) Medical Care for Adults With Down Syndrome: Guidelines From the Global Down Syndrome Foundation evidence-based method (a guideline) USA Very Short Results: 1. High rates of diabetes, hypothyroidism, and early-onset dementia in adults with Down syndrome. 2. Annual screenings recommended for dementia (from age 40), thyroid (every 1–2 years), and diabetes (from age 21 if obese). 3.Social challenges like limited care access, stigma, and communication issues impact outcomes. 4.Tailored primary care improves early detection and management(9) 3 Katherine McKenzie1 & Meagan Milton1 & Glenys Smith1 & Hélène Ouellette-Kuntz (2016) Systematic Review of the Prevalence and Incidence of Intellectual Disabilities: Current Trends and Issues systematic review Switzerland Prevalence estimates of intellectual disabilities ranged widely from 0.05% to 1.55% across countries and age groups. Only two studies reported incidence, with cumulative rates between 0.62% and 1.58%. Administrative data was the most common source, but methodological differences (e.g., case definitions, age ranges) affected consistency. Males had consistently higher prevalence than females in nearly all studies. No clear time trends emerged—some studies showed increases, others decreases or stability(10) 4 C.F. de Winter, et al. (2016) A 3-year follow-up study on cardiovascular disease and mortality in older people with intellectual disabilities Design and participants Data collection Statistical analysis The Netherlands Incidence of cardiovascular disease in older people with ID is similar to that in the general population. A proactive assessment and treatment of the presented cardiovascular disease risk factors may reduce cardiovascular disease and mortality in older people with ID(11) 5 Miguel A. Verdugo, et al (2020) A Systematic Review of the Assessment of Support Needs in People with Intellectual and Developmental Disabilities Systematic Review Spain Nine standardized tools were identified for assessing support needs, with SIS and I-CAN being the most validated. Higher support needs are associated with younger age (in children), greater intellectual disability, and co-occurring health or behavioral conditions. Support needs predict quality of life, self-determination, and resource allocation outcomes. Support needs assessments have been used to plan individualized supports and evaluate intervention effectiveness. Few intervention studies exist, and more research is needed on high-needs individuals and outcome-based strategies(12) 6 Elisabeth M. Dykens (2013) AGING IN RARE INTELLECTUAL DISABILITY SYNDROMES narrative literature review USA The review synthesizes findings on chronic health conditions, behavioral and psychiatric outcomes, and the lack of lifespan-focused research. It concludes with recommendations to improve research through genetic advances, collaborative networks, and a developmental approach to understanding aging in these populations(13) 7 Nadine Reid, et al (2020) Building Bridges to Housing for homeless adults with intellectual and developmental disabilities: outcomes of a cross-sector intervention mixed methods, longitudinal, realist-informed, observational evaluation design Canada Cross-sector approaches can improve outcomes for homeless adults with IDD and may have an important role in supporting this marginalized population(14) 8 van den Bemd, et al (2023) Chronic disease management in patients with and without intellectual disabilities: a matched study in Dutch general practice observational matched study design England Although DMPs do not specifically address the needs of chronically ill patients with ID, these patients do not seem underserved in the management of chronic diseases in terms of consultation, medication, and tests(15) 9 Milou van den Bemd, et al (2022) Chronic diseases and comorbidities in adults with and withoutintellectual disabilities: comparative cross-sectional study in Dutch general practice retrospective cross-sectional population-based design The Netherlands This study identified a younger onset of chronic illness and a higher prevalence of multiple comorbidities among people with ID in general practice than those without ID. This underlines the complexity of people with ID and chronic diseases in general practice. As this study confirmed the earlier onset of chronic diseases and comorbidities, it is recommended to acknowledge these age differences when following chronic disease guidelines(16). 10 Laura García-Domínguez, et al (2020) Chronic Health Conditions in Aging Individuals with Intellectual Disabilities quantitative, comparative cross-sectional survey method Spain chronic constipation, urinary incontinence, thyroid disorders and obesity are the most prevalent chronic diseases among individuals with ID. In addition, this population group su_ers these health conditions more frequently than older adults without ID. Detection and early intervention in these health conditions will improve adequate access to social health services and subsequent treatment of aging adults with ID (17). 11 C.F. de Winter, et al (2013) Chronic kidney disease in older people with intellectual disability: Results of the HA-ID study Cross-sectional epidemiological study The Netherlands Chronic kidney disease was associated with higher age, Down syndrome, obesity, hypercholesterolemia, and hypothyroid disease(18). 12 Orrin Devinsky, et al (2015) Delivery of epilepsy care to adults with intellectual and developmental disabilities Expert Consensus from a Workshop USA Employment is an effective service for enhancing the vocational rehabilitation outcomes of young adults and provides valuable information for policymakers, health care providers, rehabilitation counselors, and educators(19). 13 Paul Wehman, et al (2014) Effect of Supported Employment on Vocational Rehabilitation Outcomes of Transition-Age Youth with Intellectual and Developmental Disabilities: A Case Control Study A Case Control Study USA This review highlights collective and individual outcomes in the areas of assessment, intervention, and advocacy. Further research is needed within the scope of occupational therapy and disability studies that examines environmental factors and participation outcomes in this population(20). 14 Selena E. Washington (2021) Environmental Modifications and Supports for Participation Among Adults Aging With Intellectual and Developmental Disabilities: A Scoping Review Scoping review USA Primary care providers should interpret results on disease prevalence among people with intellectual disabilities in light of the study characteristics. Researchers should always interpret prevalence rates in the context of methodology (21). 15 Milou van den Bemd, et al (2023) Exploring chronic disease prevalence in people with intellectual disabilities in primary care settings: A scoping review Scoping Review The Netherlands Chronic disease prevalence varies widely between people with and without intellectual disabilities. Diabetes (DM) is often more prevalent in people with intellectual disabilities. Ischaemic heart disease (IHD) and COPD are usually less prevalent, possibly due to underdiagnosis. Cerebrovascular disease (CVD) shows mixed results. Differences are influenced by study design, country, age group, sample size, and how intellectual disabilities were identified. Primary care data is useful but inconsistent across studies. There’s a need for better, standardized research to guide healthcare planning and prevention.(22). 16 Nancy Sohler, et al (2009) Factors Associated with Obesity and Coronary Heart Disease in People with Intellectual Disabilities quantitative, observational, cross-sectional research design USA Key findings: Age and BMI were the strongest predictors of chronic diseases. Obesity was linked to higher rates of hypertension, cholesterol, and diabetes. Down syndrome was associated with obesity and cholesterol but not hypertension. Living situation, intellectual level, and behavior problems were not significantly associated with chronic disease risk(23). 17 Shanna L Burke, et al (2019) Gap analysis of service needs for adults with neurodevelopmental disorders systematic literature review USA The study found that sexual health education, socialization, and adult-focused medical care are universal needs among the six conditions. The study indicates that health-care professionals must work toward addressing the many unmet needs in comprehensive life span care services for adult individuals with neurodevelopmental disorders(24). 18 Caroline Kassee, et al (2023) Impact of social-, health-, and disability-related factors on pregnancy outcomes in women with intellectual and developmental disabilities: A population-based latent class analysis Latent Class Analysis (LCA) Canada These findings underscore the importance of multidisciplinary care approaches tailored to the needs of at-risk women with IDD, in the preconception and perinatal periods(25). 19 Nurs Clin, xi–xiv (2003) Intellectual and developmental disabilities Narrative Literature Overview and Editorial Commentary USA Improved rights and inclusion for people with I/DD due to legal reforms. Ongoing health disparities and unmet chronic care needs. Inadequate training of healthcare professionals on I/DD care. Barriers to health promotion: physical, communication, and attitudinal. Increased focus on autonomy, human rights, and lifespan care(26) 20 R. Balogh, et al (2017) Low-trauma fractures and bone mineral density testing in adults with and without intellectual and developmental disabilities: a population study population-based retrospective cohort study Canada Adults with IDD were approximately three times more likely to experience a low-trauma fracture than adults without IDD. The largest disparity in prevalence of low trauma fractures between those with and without IDD was for men, older adults (60–64 years old) and those living in rural or lower-income neighborhoods. Post low-trauma fracture, there was no significant difference in the likelihood of receiving a BMD test between individuals with and without IDD(27). 21 Heidi Hermans, Heleen M. Evenhuis (2014) Multimorbidity in older adults with intellectual disabilities sectional research design The Netherlands 80% of adults with intellectual disabilities aged 50+ had 2 or more chronic conditions (multimorbidity). 47% had 4 or more conditions. Most common conditions: dysphagia, constipation, osteoporosis, hearing impairment. Higher multimorbidity was linked to older age, severe/profound ID, and Down syndrome. No strong disease clusters were found in factor analysis(28). 22 Corey Dupre, Emily Weidman-Evans (2017) Musculoskeletal development in patients with Down syndrome Literature Review / Narrative Review USA Low bone density and muscle strength are common in people with Down syndrome. Exercise and calcium supplements improve bone health and muscle strength. Gait training early in life improves walking and balance. Virtual reality games can increase exercise engagement. Early intervention leads to better independence and prevents complications(29). 23 Gemma Lewin, et al (2024) Nature and prevalence of long-term conditions in people with intellectual disability: retrospective longitudinal population-based study retrospective longitudinal population-based study design UK The findings of the study reinforce the high prevalence and early emergence of long-term conditions in the intellectual disability cohort. It also demonstrates the difference in the range of conditions when compared with the general population. There were differences in long-term conditions when separated by sex and age. Long-term conditions that commonly require treatment in hospitals were also revealed. Further work is required to translate the findings of this study into actionable insights. Clusters of multiple long-term conditions, trajectories, outcomes, and risk factors should be explored to optimise the understanding and longitudinal care of individuals with intellectual disabilities and long-term conditions(30). 24 Roger J. Stancliffe, et al (2023) Participation and Companions for Socially Inclusive Community Activities by U.S. Adults With Intellectual and Developmental Disabilities cross-sectional study using weighted data USA Attending community groups and religious services were each strongly associated with better friendship outcomes but were not related to loneliness. The large unmet demand for community-group participation reveals a major gap. The friendship outcomes underline the benefits of socially inclusive community participation(31). 25 Grace Rutherford, et al (2023) Pattern of multimorbidity in middle-aged and older-aged people with mild intellectual disability in Australia Comparative cross-sectional design Australia People with mild intellectual disability start developing NCDs in early to mid-adulthood and the incidence increases with age. The mean number of NCDs in mid-aged group was 0.86 (SD, 0.84) compared to 3.82 in older group (SD, 2.67)(32). 26 A.M.W. Coppus (2013) People with intellectual disability: what do we know about adulthood and life expectancy? narrative literature review The Netherlands Life expectancy of people with intellectual disabilities (ID) has increased, though still lower than the general population. Common chronic conditions include: obesity, epilepsy, thyroid disorders, sensory impairments, early dementia, and osteoporosis. Mortality is higher in those with severe/profound ID, especially in institutional settings. Condition-specific risks vary (e.g., early dementia in Down syndrome, respiratory issues in cerebral palsy). Preventive care and early intervention improve outcomes but are often lacking or delayed(33). 27 A. M. Amor, et al (2021) Perceptions of people with intellectual and developmental disabilities about COVID-19 in Spain: a cross-sectional study quantitative, cross-sectional survey design Spain Participants reported that the pandemic and subsequent lockdown have had a deleterious effect on their emotional well-being (around 60.0% of participants) and occupations (48.0% of students and 72.7% of workers). Although access to information and support was reportedly good overall, being under the age of 21 years and studying were associated with perceptions reflecting poorer access to information (V = .20 and V = .13, respectively) and well-being support (V = .15 and V = .13, respectively). Being supported by a third party to complete the survey was consistently related to perceptions of worse outcomes (34). 28 Yue Xu1, et al (2024) Racial and Ethnic Disparities in Chronic Disease Outcomes Among Adults with Intellectual and Developmental Disabilities Cross-sectional observational study USA Black adults with IDD had significantly higher rates of diabetes, hypertension, and asthma than White adults. Older age (45+), obesity, high cholesterol, and sedentary behavior were major risk factors. Living with family was linked to lower risk than living alone or in group homes. Latine adults showed no significant differences compared to White adults after adjustment(35). 29 Angela Novak Amado, et al (2013) Social Inclusion and Community Participation of Individuals with Intellectual/Developmental Disabilities Narrative Literature Review USA Adults with intellectual disabilities often have few social relationships, mostly with family, staff, or other individuals with disabilities. Loneliness is common—up to 50% report feeling lonely. Social inclusion is limited despite physical presence in communities. Barriers include age, severity of disability, lack of transportation, and limited digital access. Smaller, individualized settings and staff support improve participation. Successful interventions involve community mentorship, volunteering, and inclusive group activities(36). 30 Diane C. Millar, et al. (2006) The Impact of Augmentative and Alternative Communication Intervention on Speech Production of Individuals With Developmental Disabilities: A Research Review Systematic Literature Review USA The review identified 23 studies, involving 67 individuals. Seventeen of these studies did not establish experimental control, thereby limiting the certainty of evidence about speech outcomes. The remaining six studies, involving 27 cases, had sufficient methodological rigor for the ‘‘best evidence analysis’’ (cf. R. E. Slavin, 1986). Most of the participants (aged 2–60 years) had mental retardation or autism; the AAC interventions involved instruction in manual signs or nonelectronic aided systems. None of the 27 cases demonstrated decreases in speech production as a result of AAC intervention, 11% showed no change, and the majority (89%) demonstrated gains in speech. For the most part, the gains observed were modest, but these data may underestimate the effect of AAC intervention on speech production because there were ceiling effects(37). 31 Raquel Braga, et al (2022) The Impact of the COVID-19 Lockdown on the Cognitive Functions in Persons with Intellectual and Developmental Disabilities Switzerland The results indicate a worsening in cognitive functions (attention–concentration, abstract thought, language, and praxis) after lockdown, in both the total group of participants and the mild–moderate impairment group, and in both age groups. In the severely affected group, we found an improvement in the cognitive functions assessed after lockdown. These results are similar to those found in people with dementia and in the general ageing population(38). 32 Peter Sturmey (2012) Treatment in psychology in people with intellectual and other disabilities Literature Review / Clinical Synthesis USA People with intellectual disabilities have high rates of mental health and chronic physical conditions. Many disorders go undiagnosed or are misdiagnosed due to communication barriers and system gaps. Evidence-based treatments (like CBT and behavioral therapies) can be effective when adapted. Integrated, person-centered care in residential and primary settings improves outcomes(39). 33 Stoni Fortney and Marc J. Tass´e (2021) Urbanicity, Health, and Access to Services for People With Intellectual Disability and Developmental Disabilities quantitative, secondary data analysis USA Results of logistic regression suggest that, despite connection to disability services, the health status and access to preventive healthcare services of people with IDD generally follow patterns similar to those observed in the general population. Namely, people with IDD in non-metropolitan areas have decreased access to healthcare services, preventive healthcare utilization, and health status. Despite some exceptions, it appears effects of rurality are not completely mitigated by current state and federal efforts(40). 34 Katherine Elizabeth McDonald (2012) ‘‘We Want Respect’’: Adults with Intellectual and Developmental Disabilities Address Respect in Research multimethod qualitative approach USA Adults with intellectual disabilities want: · To be treated with respect and dignity · Inclusion in research and decision-making · Accommodations (clear language, help with forms) · Positive, supportive researcher behavior · Recognition and feedback for participation(41). 35 Paul Wehman, Fong Chan, Nicole Ditchman, and Hyun-Ju Kang (2014) Effect of Supported Employment on Vocational Rehabilitation Outcomes of Transition-Age Youth With Intellectual and Developmental Disabilities: A Case Control Study Case-control study with propensity score matching. USA Supported Employment (SE) increased employment rates for youth with intellectual and developmental disabilities. SE led to a 12.5% higher employment rate overall. The strongest effects were for: · Social Security beneficiaries who had special education (+21%) · High school graduates with intellectual disability or autism (+20%)(42). 36 Lucia Migliore, Vanessa Nicolì and Andrea Stoccoro (2021) Gender Specific Differences in Disease Susceptibility: The Role of Epigenetics Literature Review / Narrative Review Italy · Women are more prone to autoimmune diseases and have stronger immune/vaccine responses. · Men have a higher risk and worse outcomes in COVID-19 and many cancers. · Sex hormones and X chromosome epigenetics (like X-inactivation, escape genes, and miRNAs) drive these differences. · Environmental factors (e.g. stress, toxins) affect disease risk through epigenetic changes, often differently in males and females. Ask ChatGPT(43). 37 Laura García-Domínguez, et al (2020) Chronic Health Conditions in Aging Individuals with Intellectual Disabilities Cross-sectional comparative study Spain · Most common chronic illnesses in aging adults with ID: Obesity (25.3%), urinary incontinence (18.7%), chronic constipation (16.2%), thyroid disorders (12.4%) · More frequent in ID group than non-ID: Constipation, incontinence, thyroid issues, and obesity · Less frequent in ID group than non-ID: Hypertension, diabetes, chronic back pain, osteoarticular disorders · Key issue: People with ID face early aging and worse access to healthcare, so early detection and better care are needed(44). 38 Milou van den Bemd, et al (2022) Chronic diseases and comorbidities in adults with and without intellectual disabilities: comparative cross-sectional study in Dutch general practice Cross-sectional, retrospective, population-based study Netherlands · Chronic diseases (CVD, DM, COPD) are more common in people with intellectual disabilities (ID), especially at younger ages. · Males with ID have the highest burden of chronic illness and comorbidities. · People with ID are more likely to have multiple comorbidities. · Chronic diseases occur earlier in people with ID than in the general population. Ask ChatGPT(45). 39 Jiahuan Guo, et al (2024) Prevalence, risk factors and prognostic value of atrial fibrillation detected after stroke after haemorrhagic versus ischaemic stroke Multicentre cohort study China AFDAS (atrial fibrillation detected after stroke) was most common in ischaemic stroke (2.29%), less in ICH (0.80%), and lowest in SAH (0.70%). Older age and more severe strokes were key risk factors. AFDAS increased in-hospital mortality compared to normal heart rhythm (SR), similar to patients with known AF (KAF). Monitoring and prevention are essential after both ischaemic and haemorrhagic strokes(46). 40 NILMINI WIJEMUNIGE, et al (20240 The Prevalence and Epidemiological Features of Ischaemic Heart Disease in Sri Lanka Cross-sectional analysis Sri Lanka IHD prevalence in Sri Lankan adults: 3.9% (History+), 3.0% (Angina+). Higher risk with: older age, hypertension, diabetes. Women had more angina symptoms but were less often diagnosed. Lower education linked to higher IHD; household wealth was not. Urban and more developed areas had higher IHD prevalence(47). 41 J. WANG, Y.-M. DING (2021) Prevalence and risk factors of pulmonary embolism in acute exacerbation of chronic obstructive pulmonary disease and its impact on outcomes: a systematic review and meta-analysis systematic review and meta-analysis China Prevalence of PE in AE-COPD: 12.9% overall · 19.4% when all patients had CT scans · 7.8% when CT was done selectively Risk factors for PE: Recent immobilization, high D-dimer, lower limb edema, older age, deep vein thrombosis (DVT) Outcomes: PE significantly increases mortality and hospital/ICU stay in AE-COPD patients(48). 42 Kiley McLean (2023) Chronic Health Conditions among Adults with I/DD in a State Medicaid System Research Report USA 1. Social Factors in Residential Living for Adults with I/DD: · Urban/rural access differences · Race, gender, and disability type affect health · Access to Medicaid and support services is essential 2. Prevalence of Chronic Illness (Adults with I/DD, Wisconsin Medicaid): · Heart disease: Up to 75% · Diabetes: Up to 40% · Hypertension: Up to 54% · Asthma: Around 12% 3. Prevention Strategies in Primary Care: · Focus on modifiable risks: inactivity, obesity, smoking · Need for inclusive screenings and tailored interventions · Address health disparities through Medicaid policy(49). 43 Peiwen LiaoID, Claire Vajdic, Julian TrollorID, Simone Reppermund (2021) Prevalence and incidence of physical health conditions in people with intellectual disability – a systematic review systematic review UK Common chronic illnesses in adults with intellectual disability (ID): epilepsy, obesity, diabetes, hearing/vision loss, osteoporosis, and cerebral palsy. • Health outcomes: Higher rates of hospital visits, comorbidities, and early death. • Compared to the general population, People with ID have a higher risk of many chronic conditions (e.g., asthma, diabetes), but lower detected rates of some (e.g., cancer), possibly due to underdiagnosis. • Prevention: People with ID are often left out of screening programs; structured health assessments and inclusive care are needed. Most data from: UK and Scandinavia; none from low-income countries(50). 44 Pouls, Katrien, et al (2021) Adults with intellectual disabilities and mental health disorders in primary care: A scoping review A scoping review Canada 1. Social Factors in Residential Living for Adults with Intellectual Disabilities (Canada) Inclusion, autonomy, dignity, stable relationships, cultural respect, family involvement, and technology for support. 2. Chronic Illness in Primary Care – Prevalence, Outcomes, Prevention High prevalence (especially multimorbidity). Outcomes: Hospitalizations, lower quality of life, early mortality. Prevention: Screenings, lifestyle changes, patient education, tech tools. 3. How Primary Care Addresses Chronic Disease Integrated teams, early detection, digital health tools, self-management support, aging-at-home strategies(51). 45 Usha Sambamoorthi, et al (2024) Intellectual Disability (ID) and Chronic Conditions Burden among Adults: Insights from Harmonized Electronic Health Records USA Adults with ID experience a higher burden of chronic conditions than those without ID. These disparities persist even after controlling for demographic variables. Results highlight the need for: · Better chronic disease management · Improved mental health screening · More tailored care in primary care and institutional settings for adults with ID(52). 1. Prevalence of Chronic Diseases a. General Burden of Chronic Conditions in Adults with ID/IDD Adults with intellectual disabilities (ID) or intellectual and developmental disabilities (IDD) experience a significantly higher prevalence of chronic diseases compared to the general population. This elevated prevalence indicates a substantial disease burden among this population, particularly in older adults. b. Prevalence of Specific Chronic Conditions · Multimorbidity : Having two or more chronic conditions is significantly more common among adults with ID (adjusted odds ratio [aOR] = 1.92), with prevalence increasing with age (53). · Diabetes Mellitus : Prevalence varies widely—6.6% in adults with IDD, 18.8% among autistic adults, and up to 40.35% in adults with ID only. It is more common in non-metropolitan areas (aOR ≈ 1.4) (54). · Hypertension : Prevalence ranges from 15.7% in autistic individuals to over 40% in adults with ID only (55). · Hypercholesterolemia : Elevated prevalence observed in adults with ID (aOR = 3.02) (56). · Thyroid Disorders : Higher prevalence among individuals with ID (aOR = 4.10) (57). · Bipolar Disorder : More than twice as prevalent in adults with ID (aOR = 2.09) (58). · Epilepsy : Reported prevalence ranges from 9.0% to 51.8% in adults with ID (59). · Obesity/Overweight : Ranges from 3.9% to 34.8%, with higher rates in rural/small town areas (60). · Chronic Constipation : Substantially higher odds observed (OR = 11.19) (61). · Asthma : Significantly more prevalent than in the general population (62). · Heart Disease / Ischemic Heart Disease (IHD) : Extremely high prevalence—75% in adults with ID, 67% in those with Down syndrome, and 64% in autistic adults with ID (63). · Chronic Obstructive Pulmonary Disease (COPD) : Elevated prevalence in adults with ID (Prevalence Ratio = 1.52) (64). · Atrial Fibrillation (AF) : Found more frequently following ischemic stroke (2.29%) than in hemorrhagic stroke (0.80%) or subarachnoid hemorrhage (0.70%) (66). 2. Health Outcomes and Gaps in Care a. Adverse Health Outcomes · Increased Morbidity and Mortality : Adults with ID face earlier onset of chronic conditions, higher hospitalization rates, longer ICU/hospital stays, premature mortality, and reduced life expectancy (67). · Reduced Quality of Life : Greater frailty and lower overall quality of life compared to peers without ID (68). · Diagnostic Overshadowing : Conditions such as cardiovascular disease or cancer are often undiagnosed or misattributed to ID, delaying treatment and worsening outcomes (69). · Communication Barriers : Individuals with ID frequently struggle to articulate or interpret symptoms, contributing to delays in diagnosis and treatment (70). b. Gaps in Diagnosis and Management · Limited Access to Primary Care : Preventive services and regular checkups are often lacking or inadequate for this population (71). · Lack of Tailored Care Protocols : There is an urgent need for age- and condition-specific care guidelines for individuals with ID (72). · Insufficient Provider Training : Many healthcare providers lack adequate training to address the needs of adults with IDD, particularly in primary care (73). · Systemic Barriers : Challenges include transportation difficulties, high care costs, poor service coordination, and provider shortages, especially in rural areas (74). · Health Inequities : Many health disparities experienced by individuals with IDD are preventable and linked to broader social and environmental determinants (75). c. Social Determinants of Health · Health Access Inequities : Disproportionate representation of Black, Hispanic, and other minority groups in the ID population necessitates culturally competent care models (76). · Underdiagnosis of Mental Health : Depression and other mental health issues are often underrecognized, highlighting communication and social barriers to care (77). · Caregiver and Staff Needs : Effective support requires trained caregivers familiar with multimorbidity and mental health challenges in ID populations (78). · Residential Living Arrangements : Group homes may contribute to poor outcomes through limited physical activity, social isolation, and poor nutrition (79). · Geographical Disparities : Rural and small-town residents with IDD face more limited-service access and worse health outcomes than urban residents (80). · Socioeconomic Status : Higher rates of poverty, polypharmacy, and inadequate nutrition are common in residential settings and influence chronic disease risks (81). 3. Strategies for Prevention and Management in Primary Care a. Preventive Strategies in Primary Care Settings · Early Screening and Diagnosis : Enhanced screening, especially for underreported conditions like depression, is essential (82). · Tailored Chronic Disease Management : Management plans must be adapted to the specific needs of individuals with ID (83). · Provider Training : Training in communication techniques and diagnostic challenges associated with ID is critical (84). · Use of Electronic Health Records (EHRs) : Coordinated use of EHRs helps track disease patterns and facilitate care continuity (85). · Lifestyle Interventions : Promotion of healthy diets, physical activity, and self-care through customized programs (86). · Digital Health Tools : Technologies such as telehealth, smart home devices, and sensors enable early alerts and remote monitoring (87). · Vaccinations and Risk Factor Control : Routine primary care visits should include immunizations and proactive chronic disease prevention. b. Approaches to Address Prevalence and Outcomes · Integrated and Coordinated Care Models : Multidisciplinary collaboration among GPs, nurses, social workers, and specialists is necessary to manage complex health needs (88). · Proactive Health Monitoring : Use of structured screening tools like the Comprehensive Health Assessment Program (CHAP) for risk identification (89). · Patient Education and Counseling : Empowering patients to participate in care decisions and improve treatment adherence (90). · Aging-in-Place Strategies : Supporting older adults to remain in their homes with necessary services and reduced reliance on institutional care (91). · Priority Access to Preventive Services : Ensuring inclusion in national screening programs with accessible infrastructure (92). · Staff Training in Primary Care : Training GPs and frontline staff to recognize illness in non-verbal or cognitively impaired patients (93). · Data-Driven Policy Design : Leveraging insurance and public health data to design and target interventions (94). c. Social and Systemic Strategies in Residential Settings · Social Inclusion and Community Engagement : Creating meaningful opportunities for social participation and interaction (95). · Autonomy and Choice : Empowering individuals to make decisions about daily routines and personal care (96). · Dignity and Respect : Ensuring person-centered care that respects individual rights and preferences (97). In addition to mapping the prevalence, health outcomes, and management strategies of chronic diseases in adults with ID, this review also identified key risk factors, commonly used outcome measures, and notable gaps in the literature, which are summarized below: Risk Factors Identified in People with Intellectual Disabilities Numerous studies in this scoping review identified specific risk factors contributing to the increased burden of chronic diseases in adults with ID. These include both biomedical and social determinants: · Biological Risk Factors : Age, sex (e.g., higher cardiovascular risk in males), and genetic syndromes such as Down syndrome or Fragile X are consistently associated with higher prevalence of certain chronic conditions (98). · Lifestyle-Related Risks : Poor diet, physical inactivity, smoking, and lack of access to health education were frequently reported as contributing to the development or exacerbation of chronic illnesses (99). · Psychosocial Factors : Social isolation, lack of autonomy, and low levels of social participation increased vulnerability to both mental and physical health problems (100). · Health System Factors : Inadequate screening, provider bias, poor continuity of care, and insufficient follow-up contributed to missed opportunities for early prevention and intervention (101). Understanding these risk factors is essential for targeting preventive strategies and improving health outcomes in this population. 5. Outcome Measures The included studies used a wide range of outcome measures to assess the impact of chronic diseases and interventions among adults with ID. These outcomes help quantify the burden and guide improvements in care: · Clinical Outcomes : Rates of hospitalization, ICU admission, complications of chronic diseases, and mortality (102). · Functional Outcomes : Measures of mobility, activities of daily living, and frailty scores (103). · Quality of Life Indicators : Patient-reported outcomes on physical and mental health, autonomy, and social participation (104). · Health Service Utilization : Number of GP visits, emergency care usage, and preventive service uptake (105). · Psychosocial Measures : Levels of depression, anxiety, and social well-being as assessed by caregivers or validated tools (106). These diverse outcome indicators provide a more nuanced understanding of health status and care effectiveness for adults with intellectual disabilities. 6. Gaps and Limitations in the Literature Despite the growing body of evidence, this review highlights several gaps and limitations that hinder a comprehensive understanding of chronic disease care in adults with ID: · Lack of Longitudinal Studies : Most available studies are cross-sectional, limiting insights into causal pathways and disease progression (107). · Underrepresentation of Minority Populations : Ethnic and racial minority groups are often excluded or underreported in the literature (108). · Inconsistent Definitions and Measures : Variability in how intellectual disability and chronic diseases are defined or measured complicates comparison across studies (109). · Limited Focus on Intervention Outcomes : Few studies evaluate the effectiveness of tailored interventions or long-term management strategies in primary care (110). · Scarcity of Voices from Individuals with ID : Perspectives of individuals with ID themselves are rarely included in research, limiting understanding of their priorities and lived experiences (111). · Data Gaps in Low- and Middle-Income Countries : Most evidence comes from high-income settings, making it difficult to generalize findings globally (112). Addressing these gaps is crucial to inform equitable, effective, and person-centered approaches to chronic disease prevention and management for adults with intellectual disabilities. DISCUSSION This scoping review synthesized evidence from a wide range of studies to provide a comprehensive understanding of the burden, management, and care-related challenges of chronic diseases in adults with intellectual disabilities (ID) or intellectual and developmental disabilities (IDD). The findings revealed a significantly higher prevalence of chronic diseases—including diabetes, hypertension, cardiovascular disease, epilepsy, obesity, and chronic respiratory conditions—among individuals with ID/IDD compared to the general population. Multimorbidity was common and often occurred at earlier ages, contributing to increased healthcare utilization and poorer health outcomes. The review highlighted several adverse health outcomes faced by this population, such as reduced life expectancy, premature mortality, higher hospitalization rates, and diagnostic delays due to overshadowing and communication barriers. Limited access to preventive services and primary care, lack of tailored clinical guidelines, and insufficient provider training emerged as critical gaps in care. Social determinants of health, including socioeconomic disadvantage, rural residence, inadequate nutrition, and cultural barriers, further compounded the disparities in health outcomes. Several modifiable risk factors were identified, including lifestyle-related elements (e.g., physical inactivity, poor diet), environmental constraints (e.g., institutional living settings), and systemic healthcare barriers. These findings underscore the importance of developing comprehensive and inclusive care models that incorporate early screening, person-centered chronic disease management, and staff education. Furthermore, targeted use of digital tools, such as telehealth and electronic health records, may enhance monitoring and continuity of care. Despite a growing body of literature, the review identified important gaps, including a lack of longitudinal studies, underrepresentation of certain demographic subgroups (e.g., ethnic minorities), and inconsistent use of outcome measures across studies. These limitations underscore the need for more robust research methodologies and equity-focused policy development to improve the health and well-being of adults with ID/IDD. Implications for Primary Care Practice The findings of this scoping review underscore the critical role of primary care in addressing the complex health needs of adults with intellectual disabilities (ID) or intellectual and developmental disabilities (IDD). Primary care providers serve as the first point of contact and ongoing coordinators of care for this vulnerable population. However, the elevated prevalence of chronic diseases and multimorbidity, combined with communication challenges and diagnostic overshadowing, demands tailored approaches within primary care settings. There is a clear need for enhanced training and education of primary care professionals to improve their competence and confidence in managing patients with ID/IDD. This includes developing skills for effective communication, recognizing coexisting physical and mental health conditions early, and understanding the unique social determinants that affect these individuals. Implementing standardized screening tools and chronic disease management protocols adapted to the specific needs of people with ID/IDD can promote timely diagnosis and appropriate intervention. Moreover, integrating multidisciplinary teams—including nurses, social workers, and specialists—within primary care can facilitate holistic and coordinated management. The use of digital health technologies, such as electronic health records and telehealth, presents opportunities to enhance care continuity and remote monitoring, particularly in underserved or rural areas. Finally, primary care practices must advocate for equitable access to preventive services and culturally competent care to reduce health disparities and improve overall outcomes for adults with intellectual disabilities. Implications for Research and Policy This scoping review highlights significant gaps in the current evidence base regarding the health status, risk factors, and effective management strategies for adults with intellectual disabilities (ID) or intellectual and developmental disabilities (IDD). Future research should prioritize longitudinal studies to understand better the progression of chronic diseases and the impact of tailored interventions in this population. There is also a need for more inclusive research designs that actively involve individuals with ID/IDD and their caregivers to ensure the relevance and applicability of findings. Policy frameworks must recognize the unique health challenges faced by adults with ID/IDD and promote the development and implementation of comprehensive care models within primary care. Policymakers should advocate for increased funding and resources dedicated to training healthcare providers, improving access to preventive services, and addressing social determinants of health that disproportionately affect this group. Additionally, policies encouraging the integration of health and social care services can improve coordination and reduce systemic barriers. Data collection systems should be enhanced to capture detailed information on health outcomes and service utilization among people with intellectual disabilities, enabling data-driven policy decisions. Finally, culturally competent and equitable care approaches must be embedded in health policies to address disparities experienced by minority groups within the ID/IDD population, ensuring that all individuals receive appropriate and respectful care. Strengths and Limitations of the Review This scoping review offers a comprehensive synthesis of the current evidence regarding the prevalence, health outcomes, risk factors, and management strategies for chronic diseases in adults with intellectual disabilities (ID) or intellectual and developmental disabilities (IDD). A key strength of this review lies in its broad inclusion criteria, encompassing a diverse range of study designs, populations, and settings, which provides a holistic understanding of the health challenges faced by this vulnerable group. The systematic approach to data extraction and thematic synthesis ensures transparency and reproducibility, enhancing the reliability of the findings. However, several limitations should be acknowledged. Firstly, the heterogeneity of included studies, in terms of methodology, sample size, and outcome measures, limits the ability to perform meta-analysis or draw definitive conclusions about causality or intervention effectiveness. Secondly, the reliance on published literature may introduce publication bias, potentially overlooking unpublished data or grey literature that could provide additional insights. Thirdly, many studies originated from high-income countries, which may limit the generalizability of findings to low- and middle-income settings with differing healthcare infrastructures and social determinants. Finally, language restrictions and the exclusion of non-English publications might have led to the omission of relevant studies. Despite these limitations, this review provides valuable foundational knowledge to guide future research, policy, and clinical practice aimed at improving health outcomes for adults with ID/IDD. CONCLUSION This scoping review highlights the substantial burden of chronic diseases among adults with intellectual and developmental disabilities, revealing significant disparities in prevalence, health outcomes, and access to care compared to the general population. The findings emphasize the complexity of managing multimorbidity in this group and the critical gaps in tailored healthcare provision within primary care settings. Addressing these challenges requires integrated, multidisciplinary approaches and the development of specialized care protocols that accommodate the unique needs of individuals with ID/IDD. Moreover, the review underscores the urgent need for enhanced provider training, improved health system coordination, and the incorporation of social determinants into care planning to reduce health inequities. While preventive strategies and innovative digital health tools offer promising avenues, systemic barriers and inequities must be addressed to effectively optimize health outcomes. Overall, this review provides a comprehensive foundation for guiding future research, informing policy development, and enhancing clinical practice to promote equitable, person-centered care for adults with intellectual disabilities who live with chronic diseases. Recommendations for Future Research Despite the growing body of evidence on chronic diseases in adults with intellectual and developmental disabilities, significant gaps remain that warrant further investigation. Future research should focus on longitudinal studies to better understand the progression and long-term outcomes of multimorbidity within this population. There is also a critical need for intervention studies that evaluate the effectiveness of tailored preventive and management strategies in primary care settings. Research should prioritize the development and validation of assessment tools specifically designed for individuals with ID/IDD to improve early detection and diagnosis of chronic conditions. 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The experience of social inclusion for people with intellectual disability within community recreational programs: A systematic review. Journal of Intellectual & Developmental Disability. 2018 Oct 2;43(4):381-91. Kuld PB, Frielink N, Zijlmans M, Schuengel C, Embregts PJ. Promoting self-determination of persons with severe or profound intellectual disabilities: A systematic review and meta-analysis. Journal of Intellectual Disability Research. 2023 Jul;67(7):589-629. Ratti V, Hassiotis A, Crabtree J, Deb S, Gallagher P, Unwin G. The effectiveness of person-centred planning for people with intellectual disabilities: A systematic review. Research in developmental disabilities. 2016 Oct 1;57:63-84. Leonard H, Montgomery A, Wolff B, Strumpher E, Masi A, Woolfenden S, Williams K, Eapen V, Finlay-Jones A, Whitehouse A, Symons M. A systematic review of the biological, social, and environmental determinants of intellectual disability in children and adolescents. Frontiers in Psychiatry. 2022 Aug 25;13:926681. Robertson J, Emerson E, Gregory N, Hatton C, Turner S, Kessissoglou S, Hallam A. Lifestyle related risk factors for poor health in residential settings for people with intellectual disabilities. Research in developmental disabilities. 2000 Nov 1;21(6):469-86. Alves NS, Gavina VP, Cortellazzi KL, Antunes LA, Silveira FM, Assaf AV. Analysis of clinical, demographic, socioeconomic, and psychosocial determinants of quality of life of persons with intellectual disability: a cross-sectional Study. Special Care in Dentistry. 2016 Nov;36(6):307-14. Sonderlund AL, Baygi F, Soendergaard J, Thilsing T. Advancing health equity for populations with intellectual disabilities: a systematic review of facilitators and barriers to the implementation of health checks and screening. SSM-Health Systems. 2024 Jun 1;2:100009. Goddard L, Davidson PM, Daly J, Mackey S. People with an intellectual disability in the discourse of chronic and complex conditions: an invisible group?. Australian Health Review. 2008;32(3):405-14. Verdonschot MM, De Witte LP, Reichrath E, Buntinx WH, Curfs LM. Impact of environmental factors on community participation of persons with an intellectual disability: a systematic review. Journal of intellectual disability research. 2009 Jan;53(1):54-64. Ramerman L, Hoekstra PJ, de Kuijper G. Health-related quality of life in people with intellectual disability who use long-term antipsychotic drugs for challenging behaviour. Research in Developmental Disabilities. 2018 Apr 1;75:49-58. Melville CA, Finlayson J, Cooper SA, Allan L, Robinson N, Burns E, Martin G, Morrison J. Enhancing primary health care services for adults with intellectual disabilities. Journal of Intellectual Disability Research. 2005 Mar;49(3):190-8. Cooper SA, Smiley E, Morrison J, Williamson A, Allan L. Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. The British journal of psychiatry. 2007 Jan;190(1):27-35. McCarron M, McCausland D, McGlinchey E, Bowman S, Foley M, Haigh M, Burke E, McCallion P. Recruitment and retention in longitudinal studies of people with intellectual disability: A case study of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Hussain-Gambles M, Atkin K, Leese B. Why ethnic minority groups are under-represented in clinical trials: a review of the literature. Health & social care in the community. 2004 Sep;12(5):382-8. Maulik PK, Mascarenhas MN, Mathers CD, Dua T, Saxena S. Prevalence of intellectual disability: a meta-analysis of population-based studies. Research in developmental disabilities. 2011 Mar 1;32(2):419-36. Emerson E, Hatton C. Health inequalities and people with intellectual disabilities. Cambridge University Press; 2014. Kahonde CK. A call to give a voice to people with intellectual disabilities in Africa through inclusive research. African Journal of Disability. 2023 Apr 25;12:1127. Lund C, Tomlinson M, Patel V. Integration of mental health into primary care in low-and middle-income countries: the PRIME mental healthcare plans. The British Journal of Psychiatry. 2016 Jan;208(s56):s1-3. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7552881","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":511263308,"identity":"3d0c0253-b9f7-4244-9533-7bae1adb714e","order_by":0,"name":"Hasheem Mannan","email":"","orcid":"","institution":"University College Dublin","correspondingAuthor":false,"prefix":"","firstName":"Hasheem","middleName":"","lastName":"Mannan","suffix":""},{"id":511263309,"identity":"5385b7ef-5b3e-4dce-99e8-3f627b7121b9","order_by":1,"name":"Sahar Nasri","email":"","orcid":"","institution":"Art University of Isfahan","correspondingAuthor":false,"prefix":"","firstName":"Sahar","middleName":"","lastName":"Nasri","suffix":""},{"id":511263310,"identity":"d0f58a3e-9386-4807-9ccc-6603002119d4","order_by":2,"name":"Aala Abtin","email":"","orcid":"","institution":"Medical University of Isfahan","correspondingAuthor":false,"prefix":"","firstName":"Aala","middleName":"","lastName":"Abtin","suffix":""},{"id":511263311,"identity":"c452f068-5ad9-4ff4-84e4-85698ce10771","order_by":3,"name":"Maryam Kazemi","email":"","orcid":"","institution":"Maynooth University","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Kazemi","suffix":""},{"id":511263327,"identity":"02642deb-85d2-48d9-a377-c8ece458cc85","order_by":4,"name":"Hamidreza Rabiei-Dastjerdi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYBACAyA+wANiMDMwHP75558cSPTAA6K1MDYcMAZrSSCghYEHymAGaklsAIng02LOfjrxwBuGe/Lm7MwHDxfuuJM+P+zwQ6AtdnK6Ddi1WPbkbjg4h6HYcGczW8LhmWee5W68nWYA1JJsbHYAh8MO5G44zMOQwAgkDQ7wsDHnbpydANJyIHEbLi3n34K12G84zP8BpCXdcHb6B/xabkBsSQSRh3nbDifIS+cQsOXGW6BfDBKSgX4xODjjTJrhBumcggMJBnj8cj5384c3FQm22/kPP/7wocJGXn52+mYgw04OlxaoRpQAQRchCOQbSFE9CkbBKBgFIwEAAI59bb4tBuimAAAAAElFTkSuQmCC","orcid":"","institution":"Dublin City University","correspondingAuthor":true,"prefix":"","firstName":"Hamidreza","middleName":"","lastName":"Rabiei-Dastjerdi","suffix":""}],"badges":[],"createdAt":"2025-09-06 20:10:11","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7552881/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7552881/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90901694,"identity":"b4637c98-e203-4bca-b968-55520228dd90","added_by":"auto","created_at":"2025-09-09 12:24:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":58555,"visible":true,"origin":"","legend":"\u003cp\u003ePrisma flow chart\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7552881/v1/a2c42fcda940bff7b97f94e0.png"},{"id":90902767,"identity":"86b85253-faa3-4a19-8bf9-2f49cb9ec402","added_by":"auto","created_at":"2025-09-09 12:40:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2431184,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7552881/v1/8bc79055-0e8c-477e-9aab-1abd94914ff9.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003ePrevalence, Risk Factors, and Outcomes of Chronic Diseases in Adults with Intellectual Disabilities: A Scoping Review of Primary Care Evidence\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eChronic diseases represent a significant burden on healthcare systems worldwide and are among the leading causes of disability, reduced quality of life, and premature death. Adults with intellectual disabilities (ID) are particularly vulnerable to these conditions due to a combination of biological, social, and systemic factors. The high prevalence of chronic diseases in this population underscores the importance of early identification, targeted prevention, and continuous care strategies (1).\u003c/p\u003e\u003cp\u003eDespite growing attention to health disparities, individuals with intellectual disabilities remain underserved in many aspects of healthcare, particularly in the management and prevention of chronic diseases. These individuals often face multiple barriers, including communication difficulties, limited health literacy, and inadequate access to primary care services (2). Moreover, health data regarding adults with ID are often fragmented or underreported, leading to gaps in planning and service delivery (3).\u003c/p\u003e\u003cp\u003ePrimary care plays a critical role in the early detection and ongoing management of chronic diseases. It serves as a frontline platform for preventive interventions, patient education, and continuity of care. For adults with intellectual disabilities, accessible and inclusive primary care is essential to address both general health needs and condition-specific risks (4).\u003c/p\u003e\u003cp\u003eIn recent years, several studies have explored the prevalence of chronic diseases such as ischemic heart disease, diabetes, cerebrovascular disease, and chronic obstructive pulmonary disease in adults with ID. For example, (5) found that adults with ID are significantly more likely to develop diabetes compared to the general population. In another study, (6) highlighted the increased risk of cardiovascular diseases in this group, partly due to sedentary lifestyles and medication side effects. Similarly, (7) identified poor care coordination and limited follow-up as contributors to poor health outcomes in this population.\u003c/p\u003e\u003cp\u003eAlthough there is an expanding body of literature, a comprehensive synthesis of evidence regarding the \u003cb\u003eprevalence, risk factors, and outcomes\u003c/b\u003e of chronic diseases in adults with intellectual disabilities remains limited. To address this gap, the present study adopts a \u003cb\u003escoping review approach\u003c/b\u003e to map the existing evidence within the context of \u003cb\u003eprimary care\u003c/b\u003e. The findings aim to inform policymakers, healthcare professionals, and researchers in designing more effective and inclusive health interventions for adults with intellectual disabilities.\u003c/p\u003e\u003cp\u003eResearch Questions\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eWhat are the social factors to include in the residential living (institutional living) of adults with intellectual disabilities?\u003c/b\u003e\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eWhat social factors should be considered in the residential living (institutional living) of adults with intellectual disabilities?\u003c/b\u003e\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\n\u003ch3\u003e3. What is the prevalence of chronic illness, outcomes, and prevention strategies in primary care settings?\u003c/h3\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e4. What is the prevalence of chronic diseases, outcomes, and prevention strategies in primary healthcare centers?\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eRationale for the Review\u003c/p\u003e\u003cp\u003eAdults with intellectual disabilities (ID) or intellectual and developmental disabilities (IDD) represent a growing population with complex health needs. Evidence increasingly shows that this group experiences a disproportionate burden of chronic diseases\u0026mdash;including diabetes, cardiovascular disease, and chronic respiratory conditions\u0026mdash;often at younger ages and with more severe complications compared to the general population. Despite these vulnerabilities, individuals with ID/IDD frequently encounter substantial barriers in accessing high-quality primary care, including diagnostic overshadowing, communication difficulties, limited provider training, and systemic health inequities.\u003c/p\u003e\u003cp\u003ePrevious research has tended to focus on specific conditions, narrow geographic settings, or particular subpopulations (e.g., individuals with Down syndrome or autism), often using heterogeneous definitions and outcome measures. As a result, the broader landscape of chronic disease burden, associated risk factors, and health outcomes in this population remains unclear and under-synthesized, particularly within the context of primary care.\u003c/p\u003e\u003cp\u003eGiven the global emphasis on inclusive healthcare and the critical role of primary care in early detection and long-term management of chronic conditions, a comprehensive synthesis of current evidence is urgently needed. This scoping review aims to map the existing literature on the prevalence, risk factors, outcomes, and care strategies related to chronic diseases among adults with ID/IDD, identify research gaps, and inform both clinical practice and future research and policy-making in primary care settings.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis study employed a \u003cb\u003escoping review methodology\u003c/b\u003e to provide a comprehensive overview of the field related to chronic diseases among adults with intellectual disabilities, identify existing gaps in the literature, clarify key concepts, and offer a broad map of the types of evidence and actions relevant to this area. The review was conducted following the \u003cb\u003ePRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews)\u003c/b\u003e framework and included the following five stages:\u003c/p\u003e\u003cp\u003eThe present study aimed to answer the following research question: \u003cem\u003eWhat are the key factors associated with the prevalence, risk factors, and outcomes of chronic diseases in adults with intellectual disabilities within the context of primary care?\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eSystematic Literature Search:\u003c/h3\u003e\n\u003cp\u003eTo ensure comprehensive coverage of relevant studies, a systematic search was conducted across international databases including \u003cb\u003eEmbase\u003c/b\u003e, \u003cb\u003eMedline\u003c/b\u003e, \u003cb\u003ePubMed\u003c/b\u003e, and \u003cb\u003eWeb of Science\u003c/b\u003e, without restrictions on publication date or language. The search aimed to identify peer-reviewed literature related to the \u003cem\u003eprevalence, risk factors, and outcomes of chronic diseases in adults with intellectual disabilities within the context of primary care\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eThe search strategy included a combination of controlled vocabulary (e.g., MeSH terms) and free-text terms using Boolean operators \u003cb\u003eAND\u003c/b\u003e and \u003cb\u003eOR\u003c/b\u003e. The following key terms and their synonyms were used:\u003c/p\u003e\u003cp\u003e\u003cb\u003e\"Intellectual disabilities\"\u003c/b\u003e, \u003cb\u003e\"Chronic diseases\"\u003c/b\u003e, \u003cb\u003e\"Primary care\"\u003c/b\u003e, \u003cb\u003e\"Disease prevalence\"\u003c/b\u003e, \u003cb\u003e\"Health disparities\"\u003c/b\u003e, \u003cb\u003e\"Ischaemic heart disease\"\u003c/b\u003e, \u003cb\u003e\"Cerebrovascular disease\"\u003c/b\u003e, \u003cb\u003e\"Diabetes mellitus\"\u003c/b\u003e, \u003cb\u003e\"Chronic obstructive pulmonary disease\"\u003c/b\u003e, \u003cb\u003e\"Risk factors\"\u003c/b\u003e, and \u003cb\u003e\"Outcomes\"\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eThe search strategy was carefully designed to capture studies from the inception of each database until the search date. All retrieved records were imported into \u003cb\u003eEndNote\u003c/b\u003e, a reference management software, for screening and removal of duplicates.\u003c/p\u003e\u003cp\u003eIn addition to the database search, the reference lists of included studies were manually screened to identify any additional relevant publications. However, no grey literature was included, as the scope of this review was limited to peer-reviewed journal articles.\u003c/p\u003e\n\u003ch3\u003eStudy Screening and Selection\u003c/h3\u003e\n\u003cp\u003eThe inclusion criteria comprised peer-reviewed studies in English and Persian that addressed any aspect of chronic disease prevalence, risk factors, or outcomes among adults with intellectual disabilities in primary care settings. No time restrictions were applied. Exclusion criteria included studies without accessible full-text articles or those unrelated to primary care.\u003c/p\u003e\u003cp\u003eAn initial total of \u003cb\u003e1,365 records\u003c/b\u003e were identified through database searches (Embase, Medline, PubMed, Web of Science, and PsycInfo). After automatic and manual de-duplication using \u003cb\u003eEndNote\u003c/b\u003e, \u003cb\u003e1,102 unique records\u003c/b\u003e remained for screening.\u003c/p\u003e\u003cp\u003eIn the first screening phase, titles and abstracts were reviewed against the inclusion and exclusion criteria. As a result, \u003cb\u003e950 records\u003c/b\u003e were excluded due to irrelevance, and \u003cb\u003e152 studies\u003c/b\u003e were retained for full-text assessment.\u003c/p\u003e\u003cp\u003eDuring the second screening phase, full-text articles were carefully evaluated. A total of \u003cb\u003e107 studies\u003c/b\u003e were excluded for reasons including a lack of alignment with the study objectives, non-relevant target populations, or the absence of a primary care context. Finally, \u003cb\u003e45 studies\u003c/b\u003e met the eligibility criteria and were included in the scoping review.\u003c/p\u003e\u003cp\u003eFull texts of the included studies were thoroughly reviewed, and relevant data were extracted using a standardized data charting form. The screening process was independently performed by two reviewers. Discrepancies in study selection were resolved through discussion and consensus among all research team members.\u003c/p\u003e\u003cp\u003eThe complete study selection process, including the number of records at each stage and reasons for exclusion, is visually illustrated in \u003cb\u003eFig.\u0026nbsp;1\u003c/b\u003e, based on the PRISMA-ScR flow diagram.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDatabase Search Strategy\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDatabase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSearch Strategy\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmbase\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e('intellectual disability'/exp OR 'intellectual disability' OR 'developmental disability' OR 'cognitive impairment') AND ('chronic disease'/exp OR 'chronic disease' OR 'chronic illness' OR 'disease prevalence') AND ('primary health care'/exp OR 'primary care' OR 'general practice' OR 'family practice') AND ('ischaemic heart disease'/exp OR 'cerebrovascular disease'/exp OR 'diabetes mellitus'/exp OR 'chronic obstructive pulmonary disease'/exp OR 'ischaemic heart disease' OR 'cerebrovascular disease' OR 'diabetes mellitus' OR 'chronic obstructive pulmonary disease') AND ('risk factor'/exp OR 'risk factor' OR 'health outcome'/exp OR 'health outcomes' OR 'health disparity'/exp OR 'health disparities' OR 'disease outcome'/exp OR 'disease outcomes')\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMedline\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eexp Intellectual Disability/ OR \"intellectual disability\".mp. OR \"developmental disability\".mp. OR \"cognitive impairment\".mp. AND exp Chronic Disease/ OR \"chronic disease\".mp. OR \"chronic illness\".mp. OR \"disease prevalence\".mp. AND exp Primary Health Care/ OR \"primary care\".mp. OR \"general practice\".mp. OR \"family practice\".mp. AND exp Ischemic Heart Disease/ OR exp Cerebrovascular Disorders/ OR exp Diabetes Mellitus/ OR exp Pulmonary Disease, Chronic Obstructive/ OR \"ischaemic heart disease\".mp. OR \"cerebrovascular disease\".mp. OR \"diabetes mellitus\".mp. OR \"chronic obstructive pulmonary disease\".mp. AND exp Risk Factors/ OR \"risk factors\".mp. OR exp Health Status/ OR \"health outcomes\".mp. OR exp Health Disparities/ OR \"health disparities\".mp. OR exp Disease Progression/ OR \"disease outcomes\".mp.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePubMed\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e((\"Intellectual Disability\"[MeSH Terms] OR \"intellectual disability\"[tiab] OR \"developmental disability\"[tiab] OR \"cognitive impairment\"[tiab]) AND (\"Chronic Disease\"[MeSH Terms] OR \"chronic disease\"[tiab] OR \"chronic illness\"[tiab] OR \"disease prevalence\"[tiab]) AND (\"Primary Health Care\"[MeSH Terms] OR \"primary care\"[tiab] OR \"general practice\"[tiab] OR \"family practice\"[tiab]) AND (\"Ischemic Heart Disease\"[MeSH Terms] OR \"Cerebrovascular Disorders\"[MeSH Terms] OR \"Diabetes Mellitus\"[MeSH Terms] OR \"Pulmonary Disease, Chronic Obstructive\"[MeSH Terms] OR \"ischaemic heart disease\"[tiab] OR \"cerebrovascular disease\"[tiab] OR \"diabetes mellitus\"[tiab] OR \"chronic obstructive pulmonary disease\"[tiab]) AND (\"Risk Factors\"[MeSH Terms] OR \"risk factors\"[tiab] OR \"health outcomes\"[tiab] OR \"health disparities\"[tiab] OR \"disease outcomes\"[tiab]))\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWeb of Science\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTS=(\"intellectual disability\" OR \"developmental disability\" OR \"cognitive impairment\") AND TS=(\"chronic disease\" OR \"chronic illness\" OR \"disease prevalence\") AND TS=(\"primary care\" OR \"general practice\" OR \"family practice\") AND TS=(\"ischaemic heart disease\" OR \"cerebrovascular disease\" OR \"diabetes mellitus\" OR \"chronic obstructive pulmonary disease\") AND TS=(\"risk factors\" OR \"health outcomes\" OR \"health disparities\" OR \"disease outcomes\")\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePsycINFO\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eexp Intellectual Disability/ OR \"intellectual disability\".mp. OR \"developmental disability\".mp. OR \"cognitive impairment\".mp. AND exp Chronic Disease/ OR \"chronic disease\".mp. OR \"chronic illness\".mp. OR \"disease prevalence\".mp. AND exp Primary Health Care/ OR \"primary care\".mp. OR \"general practice\".mp. OR \"family practice\".mp. AND exp Ischemic Heart Disease/ OR exp Cerebrovascular Disorders/ OR exp Diabetes Mellitus/ OR exp Chronic Obstructive Pulmonary Disease/ OR \"ischaemic heart disease\".mp. OR \"cerebrovascular disease\".mp. OR \"diabetes mellitus\".mp. OR \"chronic obstructive pulmonary disease\".mp. AND exp Risk Factors/ OR \"risk factors\".mp. OR exp Health Outcomes/ OR \"health outcomes\".mp. OR exp Health Disparities/ OR \"health disparities\".mp. OR exp Disease Progression/ OR \"disease outcomes\".mp.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eData Extraction and Analysis\u003c/h3\u003e\n\u003cp\u003eIn this stage, bibliographic and content-related data were extracted from the included studies and recorded in a structured data charting table. The table encompassed key elements such as the authors\u0026rsquo; names, year of publication, country or region of study, research objectives, study type and methodology, target population, and key findings relevant to the prevalence, risk factors, and outcomes of chronic diseases among adults with intellectual disabilities in primary care settings.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003ePresentation of Results and Discussion\u003c/h2\u003e\u003cp\u003eQualitative data analysis was conducted using a thematic analysis approach, following the techniques proposed by Ryan and Bernard. The research team systematically reviewed lexical patterns, recurring phrases, explicit and implicit keywords, and compared underlying assumptions and concepts across the studies to identify central themes.\u003c/p\u003e\u003cp\u003eThe process involved iterative coding, categorization, and thematic extraction to ensure rigorous data management and traceability throughout the analysis. Regular meetings were held among the research team members to validate codes and themes, ensuring consistency and credibility. Thematic interpretation was informed by relevant theoretical frameworks, facilitating a deeper understanding of the data.\u003c/p\u003e\u003cp\u003eBased on the findings, the study provides practical recommendations aimed at improving the understanding and management of chronic diseases among adults with intellectual disabilities in primary care, while highlighting existing gaps and opportunities for future research and policy development.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe findings of this scoping review are synthesized and presented under three overarching themes: \u003cstrong\u003ePrevalence of Chronic Diseases\u003c/strong\u003e, \u003cstrong\u003eHealth Outcomes and Gaps in Care\u003c/strong\u003e, and \u003cstrong\u003eStrategies for Prevention and Management in Primary Care Settings\u003c/strong\u003e. These themes provide a comprehensive understanding of the current landscape of chronic disease burden in adults with intellectual disabilities (ID) or intellectual and developmental disabilities (IDD).\u003c/p\u003e\n\u003cp\u003eTable 2: Study Characteristics and Data Extraction Table\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor \u0026amp; Year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTitle\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethod\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCountry\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFindings\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eWilliam F. Sullivan, et al (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003ePrimary care of adults with intellectual\u003c/p\u003e\n \u003cp\u003eand developmental disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003emulti-source, consensus-based approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eCanada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eIts outcome is a robust, multi-dimensional framework for improving primary care for adults with intellectual and developmental disabilities in Canada. It addresses gaps from the 2011 guidelines and incorporates current evidence, expert experience, and stakeholder needs(8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;The Global Down Syndrome Foundation (GLOBAL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eMedical Care for Adults With Down Syndrome: Guidelines From the Global Down Syndrome Foundation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eevidence-based method (a guideline)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eVery Short Results:\u003c/p\u003e\n \u003cp\u003e1. High rates of diabetes, hypothyroidism, and early-onset dementia in adults with Down syndrome.\u003c/p\u003e\n \u003cp\u003e2. Annual screenings recommended for dementia (from age 40), thyroid (every 1\u0026ndash;2 years), and diabetes (from age 21 if obese).\u003c/p\u003e\n \u003cp\u003e3.Social challenges like limited care access, stigma, and communication issues impact outcomes.\u003c/p\u003e\n \u003cp\u003e4.Tailored primary care improves early detection and management(9)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eKatherine McKenzie1 \u0026amp; Meagan Milton1 \u0026amp; Glenys Smith1 \u0026amp; H\u0026eacute;l\u0026egrave;ne Ouellette-Kuntz (2016)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eSystematic Review of the Prevalence and Incidence of Intellectual\u003c/p\u003e\n \u003cp\u003eDisabilities: Current Trends and Issues\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003esystematic review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eSwitzerland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003ePrevalence estimates of intellectual disabilities ranged widely from 0.05% to 1.55% across countries and age groups.\u003c/p\u003e\n \u003cp\u003eOnly two studies reported incidence, with cumulative rates between 0.62% and 1.58%.\u003c/p\u003e\n \u003cp\u003eAdministrative data was the most common source, but methodological differences (e.g., case definitions, age ranges) affected consistency.\u003c/p\u003e\n \u003cp\u003eMales had consistently higher prevalence than females in nearly all studies.\u003c/p\u003e\n \u003cp\u003eNo clear time trends emerged\u0026mdash;some studies showed increases, others decreases or stability(10)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eC.F. de Winter, et al. (2016)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eA 3-year follow-up study on cardiovascular disease and\u003c/p\u003e\n \u003cp\u003emortality in older people with intellectual disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eDesign and participants\u003c/p\u003e\n \u003cp\u003eData collection\u003c/p\u003e\n \u003cp\u003eStatistical analysis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eThe Netherlands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eIncidence of cardiovascular disease in older people with ID is similar to that in\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003ethe general population. A proactive assessment and treatment of the presented\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003ecardiovascular disease risk factors may reduce cardiovascular disease and mortality in\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eolder people with ID(11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eMiguel A. Verdugo, et al (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eA Systematic Review of the Assessment of Support\u003c/p\u003e\n \u003cp\u003eNeeds in People with Intellectual and\u003c/p\u003e\n \u003cp\u003eDevelopmental Disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eSystematic Review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eSpain\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eNine standardized tools were identified for assessing support needs, with SIS and I-CAN being the most validated.\u003c/p\u003e\n \u003cp\u003eHigher support needs are associated with younger age (in children), greater intellectual disability, and co-occurring health or behavioral conditions.\u003c/p\u003e\n \u003cp\u003eSupport needs predict quality of life, self-determination, and resource allocation outcomes.\u003c/p\u003e\n \u003cp\u003eSupport needs assessments have been used to plan individualized supports and evaluate intervention effectiveness.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Few intervention studies exist, and more research is needed on high-needs individuals and outcome-based strategies(12)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eElisabeth M. Dykens (2013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eAGING IN RARE INTELLECTUAL DISABILITY\u003c/p\u003e\n \u003cp\u003eSYNDROMES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003enarrative literature review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThe review synthesizes findings on chronic health conditions, behavioral and psychiatric outcomes, and the lack of lifespan-focused research. It concludes with recommendations to improve research through genetic advances, collaborative networks, and a developmental approach to understanding aging in these populations(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNadine Reid, et al (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eBuilding Bridges to Housing for homeless adults with intellectual\u003c/p\u003e\n \u003cp\u003eand developmental disabilities: outcomes of a cross-sector\u003c/p\u003e\n \u003cp\u003eintervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003emixed methods, longitudinal, realist-informed, observational evaluation design\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eCanada\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eCross-sector approaches can improve outcomes for homeless adults with IDD and may have an important role in supporting this marginalized population(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003evan den Bemd, et al (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eChronic disease management in patients with and without\u003c/p\u003e\n \u003cp\u003eintellectual disabilities: a matched study in Dutch general\u003c/p\u003e\n \u003cp\u003epractice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eobservational matched study design\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eEngland\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eAlthough DMPs do not specifically address the needs of chronically ill patients with ID, these patients do not seem underserved in the management of chronic diseases in terms of consultation, medication, and tests(15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eMilou van den Bemd, et al (2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eChronic diseases and comorbidities in adults with and\u003c/p\u003e\n \u003cp\u003ewithoutintellectual disabilities: comparative\u003c/p\u003e\n \u003cp\u003ecross-sectional study in Dutch general practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eretrospective cross-sectional population-based design\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eThe Netherlands\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThis study identified a younger onset of chronic illness and a higher prevalence of multiple comorbidities among people with ID in\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003egeneral practice than those without ID. This underlines the complexity of people with ID and chronic diseases in general practice. As this study\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003econfirmed the earlier onset of chronic diseases and comorbidities, it is recommended to acknowledge these age differences when following\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003echronic disease guidelines(16).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eLaura Garc\u0026iacute;a-Dom\u0026iacute;nguez, et al (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eChronic Health Conditions in Aging Individuals with\u003c/p\u003e\n \u003cp\u003eIntellectual Disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003equantitative, comparative cross-sectional survey method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eSpain\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003echronic constipation, urinary\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eincontinence, thyroid disorders and obesity are the most prevalent chronic diseases among individuals with ID. In addition, this population group su_ers these health conditions more frequently than older\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eadults without ID. Detection and early intervention in these health conditions will improve adequate access to social health services and subsequent treatment of aging adults with ID (17).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eC.F. de Winter, et al (2013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eChronic kidney disease in older people with intellectual\u003c/p\u003e\n \u003cp\u003edisability: Results of the HA-ID study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eCross-sectional epidemiological study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eThe Netherlands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eChronic kidney disease\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003ewas associated with higher age, Down syndrome, obesity, hypercholesterolemia, and\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003ehypothyroid disease(18).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eOrrin Devinsky, et al (2015)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eDelivery of epilepsy care to adults with\u003c/p\u003e\n \u003cp\u003eintellectual and developmental disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eExpert Consensus from a Workshop\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eEmployment is an effective service for enhancing the vocational rehabilitation outcomes of young adults and provides valuable information for policymakers, health care providers, rehabilitation counselors, and educators(19).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003ePaul Wehman, et al (2014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eEffect of Supported Employment on Vocational Rehabilitation\u003c/p\u003e\n \u003cp\u003eOutcomes of Transition-Age Youth with Intellectual and\u003c/p\u003e\n \u003cp\u003eDevelopmental Disabilities: A Case Control Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eA Case Control Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThis review highlights collective and individual outcomes in the areas of assessment, intervention, and advocacy. Further research is needed within the scope of occupational therapy and disability studies that examines environmental factors and participation outcomes in this population(20).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eSelena E. Washington (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eEnvironmental Modifications and Supports\u003c/p\u003e\n \u003cp\u003efor Participation Among Adults Aging With\u003c/p\u003e\n \u003cp\u003eIntellectual and Developmental Disabilities: A\u003c/p\u003e\n \u003cp\u003eScoping Review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eScoping review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003ePrimary care providers should interpret results on disease prevalence among people with intellectual disabilities in light of the study characteristics.\u003c/p\u003e\n \u003cp\u003eResearchers should always interpret prevalence rates in the context of methodology (21).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eMilou van den Bemd, et al (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eExploring chronic disease prevalence in people with\u003c/p\u003e\n \u003cp\u003eintellectual disabilities in primary care settings: A scoping\u003c/p\u003e\n \u003cp\u003ereview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eScoping Review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eThe Netherlands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eChronic disease prevalence varies widely between people with and without intellectual disabilities.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Diabetes (DM) is often more prevalent in people with intellectual disabilities.\u003c/p\u003e\n \u003cp\u003eIschaemic heart disease (IHD) and COPD are usually less prevalent, possibly due to underdiagnosis.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Cerebrovascular disease (CVD) shows mixed results.\u003c/p\u003e\n \u003cp\u003eDifferences are influenced by study design, country, age group, sample size, and how intellectual disabilities were identified.\u003c/p\u003e\n \u003cp\u003ePrimary care data is useful but inconsistent across studies.\u003c/p\u003e\n \u003cp\u003eThere\u0026rsquo;s a need for better, standardized research to guide healthcare planning and prevention.(22).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNancy Sohler, et al (2009)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eFactors Associated with Obesity and Coronary\u003c/p\u003e\n \u003cp\u003eHeart Disease in People with Intellectual\u003c/p\u003e\n \u003cp\u003eDisabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003equantitative, observational, cross-sectional research design\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eKey findings:\u003c/p\u003e\n \u003cp\u003eAge and BMI were the strongest predictors of chronic diseases.\u003c/p\u003e\n \u003cp\u003eObesity was linked to higher rates of hypertension, cholesterol, and diabetes.\u003c/p\u003e\n \u003cp\u003eDown syndrome was associated with obesity and cholesterol but not hypertension.\u003c/p\u003e\n \u003cp\u003eLiving situation, intellectual level, and behavior problems were not significantly associated with chronic disease risk(23).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eShanna L Burke, et al (2019)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eGap analysis of service\u003c/p\u003e\n \u003cp\u003eneeds for adults with\u003c/p\u003e\n \u003cp\u003eneurodevelopmental\u003c/p\u003e\n \u003cp\u003edisorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003esystematic literature review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThe study found that sexual health education, socialization, and adult-focused medical care are universal needs among the six conditions. The study indicates that health-care professionals must work toward\u003c/p\u003e\n \u003cp\u003eaddressing the many unmet needs in comprehensive life span care services for adult individuals with neurodevelopmental disorders(24).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eCaroline Kassee, et al (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eImpact of social-, health-, and disability-related factors on pregnancy\u003c/p\u003e\n \u003cp\u003eoutcomes in women with intellectual and developmental disabilities:\u003c/p\u003e\n \u003cp\u003eA population-based latent class analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eLatent Class Analysis (LCA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eCanada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThese findings underscore the importance of multidisciplinary care approaches tailored to the needs of at-risk women with IDD, in the preconception and perinatal periods(25).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNurs Clin, xi\u0026ndash;xiv (2003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eIntellectual and developmental disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNarrative Literature Overview and Editorial Commentary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eImproved rights and inclusion for people with I/DD due to legal reforms.\u003c/p\u003e\n \u003cp\u003eOngoing health disparities and unmet chronic care needs.\u003c/p\u003e\n \u003cp\u003eInadequate training of healthcare professionals on I/DD care.\u003c/p\u003e\n \u003cp\u003eBarriers to health promotion: physical, communication, and attitudinal.\u003c/p\u003e\n \u003cp\u003eIncreased focus on autonomy, human rights, and lifespan care(26)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eR. Balogh, et al (2017)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eLow-trauma fractures and bone mineral density testing in adults\u003c/p\u003e\n \u003cp\u003ewith and without intellectual and developmental disabilities:\u003c/p\u003e\n \u003cp\u003ea population study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003epopulation-based retrospective cohort study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eCanada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eAdults with IDD were approximately three times more likely to experience a low-trauma fracture than adults\u003c/p\u003e\n \u003cp\u003ewithout IDD. The largest disparity in prevalence of low trauma fractures between those with and without IDD was for men, older adults (60\u0026ndash;64 years old) and those living in rural or lower-income neighborhoods. Post low-trauma fracture, there was no significant difference in the likelihood of receiving a BMD test between individuals with and without IDD(27).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eHeidi Hermans, Heleen M. Evenhuis (2014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eMultimorbidity in older adults with intellectual disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003esectional research design\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eThe Netherlands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e80% of adults with intellectual disabilities aged 50+ had 2 or more chronic conditions (multimorbidity).\u003c/p\u003e\n \u003cp\u003e47% had 4 or more conditions.\u003c/p\u003e\n \u003cp\u003eMost common conditions: dysphagia, constipation, osteoporosis, hearing impairment.\u003c/p\u003e\n \u003cp\u003eHigher multimorbidity was linked to older age, severe/profound ID, and Down syndrome.\u003c/p\u003e\n \u003cp\u003eNo strong disease clusters were found in factor analysis(28).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eCorey Dupre, Emily Weidman-Evans (2017)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eMusculoskeletal development in patients with\u003c/p\u003e\n \u003cp\u003eDown syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eLiterature Review / Narrative Review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eLow bone density and muscle strength are common in people with Down syndrome.\u003c/p\u003e\n \u003cp\u003eExercise and calcium supplements improve bone health and muscle strength.\u003c/p\u003e\n \u003cp\u003eGait training early in life improves walking and balance.\u003c/p\u003e\n \u003cp\u003eVirtual reality games can increase exercise engagement.\u003c/p\u003e\n \u003cp\u003eEarly intervention leads to better independence and prevents complications(29).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eGemma Lewin, et al (2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eNature and prevalence of long-term\u003c/p\u003e\n \u003cp\u003econditions in people with intellectual\u003c/p\u003e\n \u003cp\u003edisability: retrospective longitudinal\u003c/p\u003e\n \u003cp\u003epopulation-based\u003c/p\u003e\n \u003cp\u003estudy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eretrospective longitudinal population-based study design\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThe findings of the study reinforce the high prevalence and early emergence of long-term conditions in the intellectual disability cohort. It also demonstrates the difference in the range of conditions when compared with the general population. There were differences in long-term conditions when separated by sex and age. Long-term conditions that commonly require treatment in hospitals were also revealed. Further work is required to translate the findings of this study into actionable insights. Clusters of multiple long-term conditions, trajectories, outcomes, and risk factors should be explored to optimise the understanding and longitudinal care of individuals with intellectual disabilities and long-term conditions(30).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eRoger J. Stancliffe, et al\u003c/p\u003e\n \u003cp\u003e(2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eParticipation and Companions for Socially Inclusive Community\u003c/p\u003e\n \u003cp\u003eActivities by U.S. Adults With Intellectual and Developmental\u003c/p\u003e\n \u003cp\u003eDisabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003ecross-sectional study using weighted data\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eAttending community groups and religious services were each strongly associated with better friendship outcomes but were not related to loneliness. The large unmet demand for community-group participation reveals a major gap. The friendship outcomes underline the benefits of socially inclusive community participation(31).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eGrace Rutherford, et al (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003ePattern of multimorbidity in middle-aged and older-aged\u003c/p\u003e\n \u003cp\u003epeople with mild intellectual disability in Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eComparative cross-sectional design\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eAustralia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003ePeople with mild intellectual disability start developing NCDs in early to mid-adulthood and the incidence increases with age. The mean number of NCDs in mid-aged group was 0.86 (SD, 0.84) compared to 3.82 in older group (SD, 2.67)(32).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eA.M.W. Coppus (2013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003ePeople with intellectual disability:\u003c/p\u003e\n \u003cp\u003ewhat do we know about adulthood\u003c/p\u003e\n \u003cp\u003eand life expectancy?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003enarrative literature review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eThe Netherlands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eLife expectancy of people with intellectual disabilities (ID) has increased, though still lower than the general population.\u003c/p\u003e\n \u003cp\u003eCommon chronic conditions include: obesity, epilepsy, thyroid disorders, sensory impairments, early dementia, and osteoporosis.\u003c/p\u003e\n \u003cp\u003eMortality is higher in those with severe/profound ID, especially in institutional settings.\u003c/p\u003e\n \u003cp\u003eCondition-specific risks vary (e.g., early dementia in Down syndrome, respiratory issues in cerebral palsy).\u003c/p\u003e\n \u003cp\u003ePreventive care and early intervention improve outcomes but are often lacking or delayed(33).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eA. M. Amor, et al (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003ePerceptions of people with intellectual and developmental\u003c/p\u003e\n \u003cp\u003edisabilities about COVID-19 in Spain: a cross-sectional\u003c/p\u003e\n \u003cp\u003estudy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003equantitative, cross-sectional survey design\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eSpain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eParticipants reported that the pandemic and subsequent lockdown have had a deleterious effect on their emotional well-being (around 60.0% of\u003c/p\u003e\n \u003cp\u003eparticipants) and occupations (48.0% of students and 72.7% of workers). Although access to information and support was reportedly good overall, being under the age of 21 years and studying were associated with\u003c/p\u003e\n \u003cp\u003eperceptions reflecting poorer access to information (V = .20 and V = .13, respectively) and well-being support (V = .15 and V = .13, respectively). Being\u003c/p\u003e\n \u003cp\u003esupported by a third party to complete the survey was consistently related to perceptions of worse outcomes\u0026nbsp;(34).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYue Xu1, et al (2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eRacial and Ethnic Disparities in Chronic Disease Outcomes Among Adults with Intellectual and Developmental Disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eCross-sectional observational study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eBlack adults with IDD had significantly higher rates of diabetes, hypertension, and asthma than White adults.\u003c/p\u003e\n \u003cp\u003eOlder age (45+), obesity, high cholesterol, and sedentary behavior were major risk factors.\u003c/p\u003e\n \u003cp\u003eLiving with family was linked to lower risk than living alone or in group homes.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Latine adults showed no significant differences compared to White adults after adjustment(35).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eAngela Novak Amado, et al (2013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eSocial Inclusion and Community Participation of Individuals with\u003c/p\u003e\n \u003cp\u003eIntellectual/Developmental Disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNarrative Literature Review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eAdults with intellectual disabilities often have few social relationships, mostly with family, staff, or other individuals with disabilities.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Loneliness is common\u0026mdash;up to 50% report feeling lonely.\u003c/p\u003e\n \u003cp\u003eSocial inclusion is limited despite physical presence in communities.\u003c/p\u003e\n \u003cp\u003eBarriers include age, severity of disability, lack of transportation, and limited digital access.\u003c/p\u003e\n \u003cp\u003eSmaller, individualized settings and staff support improve participation.\u003c/p\u003e\n \u003cp\u003eSuccessful interventions involve community mentorship, volunteering, and inclusive group activities(36).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eDiane C. Millar, et al. (2006)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eThe Impact of Augmentative\u003c/p\u003e\n \u003cp\u003eand Alternative Communication\u003c/p\u003e\n \u003cp\u003eIntervention on Speech Production\u003c/p\u003e\n \u003cp\u003eof Individuals With Developmental\u003c/p\u003e\n \u003cp\u003eDisabilities: A Research Review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eSystematic Literature Review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThe review identified 23 studies, involving 67 individuals. Seventeen of these studies did not establish experimental control, thereby limiting the certainty of evidence about speech outcomes. The remaining six studies, involving 27 cases, had sufficient methodological rigor for the \u0026lsquo;\u0026lsquo;best evidence analysis\u0026rsquo;\u0026rsquo; (cf. R. E. Slavin, 1986). Most of the participants (aged 2\u0026ndash;60 years) had mental retardation or autism; the AAC\u003c/p\u003e\n \u003cp\u003einterventions involved instruction in manual signs or nonelectronic aided systems. None of the 27 cases demonstrated decreases in speech production as a result of AAC intervention, 11% showed no change, and the majority (89%) demonstrated gains in\u003c/p\u003e\n \u003cp\u003espeech. For the most part, the gains observed were modest, but these data may underestimate the effect of AAC intervention on speech production because there were ceiling effects(37).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eRaquel Braga, et al (2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eThe Impact of the COVID-19 Lockdown on the Cognitive\u003c/p\u003e\n \u003cp\u003eFunctions in Persons with Intellectual and\u003c/p\u003e\n \u003cp\u003eDevelopmental Disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eSwitzerland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThe results indicate a worsening in cognitive functions (attention\u0026ndash;concentration, abstract thought, language, and praxis) after lockdown, in both the total group of participants and the mild\u0026ndash;moderate impairment group, and in both age groups. In the severely affected group, we found an improvement in the cognitive\u003c/p\u003e\n \u003cp\u003efunctions assessed after lockdown. These results are similar to those found in people with dementia and in the general ageing population(38).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003ePeter Sturmey (2012)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eTreatment in psychology in people with intellectual and other disabilities\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eLiterature Review / Clinical Synthesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003ePeople with intellectual disabilities have high rates of mental health and chronic physical conditions.\u003c/p\u003e\n \u003cp\u003eMany disorders go undiagnosed or are misdiagnosed due to communication barriers and system gaps.\u003c/p\u003e\n \u003cp\u003eEvidence-based treatments (like CBT and behavioral therapies) can be effective when adapted.\u003c/p\u003e\n \u003cp\u003eIntegrated, person-centered care in residential and primary settings improves outcomes(39).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eStoni Fortney and Marc J. Tass\u0026acute;e (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eUrbanicity, Health, and Access to Services for People With\u003c/p\u003e\n \u003cp\u003eIntellectual Disability and Developmental Disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003equantitative, secondary data analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eResults of logistic regression\u003c/p\u003e\n \u003cp\u003esuggest that, despite connection to disability services, the health status and access to preventive healthcare services of people with IDD generally follow patterns similar to those observed in the general population. Namely, people with IDD in non-metropolitan areas\u003c/p\u003e\n \u003cp\u003ehave decreased access to healthcare services, preventive healthcare utilization, and health\u003c/p\u003e\n \u003cp\u003estatus. Despite some exceptions, it appears effects of rurality are not completely mitigated by current state and federal efforts(40).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eKatherine Elizabeth McDonald\u003cspan dir=\"RTL\"\u003e\u0026nbsp; \u0026nbsp;\u003c/span\u003e (2012)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026lsquo;\u0026lsquo;We Want Respect\u0026rsquo;\u0026rsquo;: Adults with Intellectual and\u003c/p\u003e\n \u003cp\u003eDevelopmental Disabilities Address Respect in Research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003emultimethod qualitative approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eAdults with intellectual disabilities want:\u003c/p\u003e\n \u003cp\u003e\u0026middot; To be treated with respect and dignity\u003c/p\u003e\n \u003cp\u003e\u0026middot; Inclusion in research and decision-making\u003c/p\u003e\n \u003cp\u003e\u0026middot; Accommodations (clear language, help with forms)\u003c/p\u003e\n \u003cp\u003e\u0026middot; Positive, supportive researcher behavior\u003c/p\u003e\n \u003cp\u003e\u0026middot; Recognition and feedback for participation(41).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cem\u003ePaul Wehman, Fong Chan, Nicole Ditchman, and Hyun-Ju Kang (2014)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eEffect of Supported Employment on Vocational Rehabilitation\u003c/p\u003e\n \u003cp\u003eOutcomes of Transition-Age Youth With Intellectual and\u003c/p\u003e\n \u003cp\u003eDevelopmental Disabilities: A Case Control Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eCase-control study with propensity score matching.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eSupported Employment (SE) increased employment rates for youth with intellectual and developmental disabilities.\u003c/p\u003e\n \u003cp\u003eSE led to a 12.5% higher employment rate overall.\u003c/p\u003e\n \u003cp\u003eThe strongest effects were for:\u003c/p\u003e\n \u003cp\u003e\u0026middot; Social Security beneficiaries who had special education (+21%)\u003c/p\u003e\n \u003cp\u003e\u0026middot; High school graduates with intellectual disability or autism (+20%)(42).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eLucia Migliore, Vanessa Nicol\u0026igrave; and Andrea Stoccoro (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eGender Specific Differences in Disease Susceptibility: The Role\u003c/p\u003e\n \u003cp\u003eof Epigenetics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eLiterature Review / Narrative Review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eItaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026middot; Women are more prone to autoimmune diseases and have stronger immune/vaccine responses.\u003c/p\u003e\n \u003cp\u003e\u0026middot; Men have a higher risk and worse outcomes in COVID-19 and many cancers.\u003c/p\u003e\n \u003cp\u003e\u0026middot; Sex hormones and X chromosome epigenetics (like X-inactivation, escape genes, and miRNAs) drive these differences.\u003c/p\u003e\n \u003cp\u003e\u0026middot; Environmental factors (e.g. stress, toxins) affect disease risk through epigenetic changes, often differently in males and females.\u003c/p\u003e\n \u003cp\u003eAsk ChatGPT(43).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eLaura Garc\u0026iacute;a-Dom\u0026iacute;nguez, et al (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eChronic Health Conditions in Aging Individuals with\u003c/p\u003e\n \u003cp\u003eIntellectual Disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eCross-sectional comparative study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eSpain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026middot; Most common chronic illnesses in aging adults with ID:\u003cbr\u003e\u0026nbsp;Obesity (25.3%), urinary incontinence (18.7%), chronic constipation (16.2%), thyroid disorders (12.4%)\u003c/p\u003e\n \u003cp\u003e\u0026middot; More frequent in ID group than non-ID:\u003cbr\u003e\u0026nbsp;Constipation, incontinence, thyroid issues, and obesity\u003c/p\u003e\n \u003cp\u003e\u0026middot; Less frequent in ID group than non-ID:\u003cbr\u003e\u0026nbsp;Hypertension, diabetes, chronic back pain, osteoarticular disorders\u003c/p\u003e\n \u003cp\u003e\u0026middot; Key issue: People with ID face early aging and worse access to healthcare, so early detection and better care are needed(44).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eMilou van den Bemd, et al (2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eChronic diseases and comorbidities in adults with and\u003c/p\u003e\n \u003cp\u003ewithout intellectual disabilities: comparative\u003c/p\u003e\n \u003cp\u003ecross-sectional study in Dutch general practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eCross-sectional, retrospective, population-based study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eNetherlands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026middot; Chronic diseases (CVD, DM, COPD) are more common in people with intellectual disabilities (ID), especially at younger ages.\u003c/p\u003e\n \u003cp\u003e\u0026middot; Males with ID have the highest burden of chronic illness and comorbidities.\u003c/p\u003e\n \u003cp\u003e\u0026middot; People with ID are more likely to have multiple comorbidities.\u003c/p\u003e\n \u003cp\u003e\u0026middot; Chronic diseases occur earlier in people with ID than in the general population.\u003c/p\u003e\n \u003cp\u003eAsk ChatGPT(45).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eJiahuan Guo, et al (2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003ePrevalence, risk factors and prognostic\u003c/p\u003e\n \u003cp\u003evalue of atrial fibrillation detected after\u003c/p\u003e\n \u003cp\u003estroke after haemorrhagic versus\u003c/p\u003e\n \u003cp\u003eischaemic stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eMulticentre cohort study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eChina\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eAFDAS (atrial fibrillation detected after stroke) was most common in ischaemic stroke (2.29%), less in ICH (0.80%), and lowest in SAH (0.70%).\u003c/p\u003e\n \u003cp\u003eOlder age and more severe strokes were key risk factors.\u003c/p\u003e\n \u003cp\u003eAFDAS increased in-hospital mortality compared to normal heart rhythm (SR), similar to patients with known AF (KAF).\u003c/p\u003e\n \u003cp\u003eMonitoring and prevention are essential after both ischaemic and haemorrhagic strokes(46).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNILMINI WIJEMUNIGE, et al (20240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eThe Prevalence and Epidemiological Features of Ischaemic Heart Disease in Sri Lanka\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eCross-sectional analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eSri Lanka\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eIHD prevalence in Sri Lankan adults: 3.9% (History+), 3.0% (Angina+).\u003c/p\u003e\n \u003cp\u003eHigher risk with: older age, hypertension, diabetes.\u003c/p\u003e\n \u003cp\u003eWomen had more angina symptoms but were less often diagnosed.\u003c/p\u003e\n \u003cp\u003eLower education linked to higher IHD; household wealth was not.\u003c/p\u003e\n \u003cp\u003eUrban and more developed areas had higher IHD prevalence(47).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eJ. WANG, Y.-M. DING (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003ePrevalence and risk factors of pulmonary\u003c/p\u003e\n \u003cp\u003eembolism in acute exacerbation of chronic\u003c/p\u003e\n \u003cp\u003eobstructive pulmonary disease and its impact on\u003c/p\u003e\n \u003cp\u003eoutcomes: a systematic review and meta-analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003esystematic review and meta-analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eChina\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003ePrevalence of PE in AE-COPD: 12.9% overall\u003c/p\u003e\n \u003cp\u003e\u0026middot; 19.4% when all patients had CT scans\u003c/p\u003e\n \u003cp\u003e\u0026middot; 7.8% when CT was done selectively\u003c/p\u003e\n \u003cp\u003eRisk factors for PE: Recent immobilization, high D-dimer, lower limb edema, older age, deep vein thrombosis (DVT)\u003c/p\u003e\n \u003cp\u003eOutcomes: PE significantly increases mortality and hospital/ICU stay in AE-COPD patients(48).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eKiley McLean (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eChronic Health Conditions among Adults with I/DD in a State Medicaid System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eResearch Report\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1. Social Factors in Residential Living for Adults with I/DD:\u003c/p\u003e\n \u003cp\u003e\u0026middot; Urban/rural access differences\u003c/p\u003e\n \u003cp\u003e\u0026middot; Race, gender, and disability type affect health\u003c/p\u003e\n \u003cp\u003e\u0026middot; Access to Medicaid and support services is essential\u003c/p\u003e\n \u003cp\u003e2. Prevalence of Chronic Illness (Adults with I/DD, Wisconsin Medicaid):\u003c/p\u003e\n \u003cp\u003e\u0026middot; Heart disease: Up to 75%\u003c/p\u003e\n \u003cp\u003e\u0026middot; Diabetes: Up to 40%\u003c/p\u003e\n \u003cp\u003e\u0026middot; Hypertension: Up to 54%\u003c/p\u003e\n \u003cp\u003e\u0026middot; Asthma: Around 12%\u003c/p\u003e\n \u003cp\u003e3. Prevention Strategies in Primary Care:\u003c/p\u003e\n \u003cp\u003e\u0026middot; Focus on modifiable risks: inactivity, obesity, smoking\u003c/p\u003e\n \u003cp\u003e\u0026middot; Need for inclusive screenings and tailored interventions\u003c/p\u003e\n \u003cp\u003e\u0026middot; Address health disparities through Medicaid policy(49).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003ePeiwen LiaoID, Claire Vajdic, Julian TrollorID, Simone Reppermund (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003ePrevalence and incidence of physical health\u003c/p\u003e\n \u003cp\u003econditions in people with intellectual disability\u003c/p\u003e\n \u003cp\u003e\u0026ndash; a systematic review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003esystematic review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eCommon chronic illnesses in adults with intellectual disability (ID): epilepsy, obesity, diabetes, hearing/vision loss, osteoporosis, and cerebral palsy.\u003c/p\u003e\n \u003cp\u003e\u0026bull; \u0026nbsp;Health outcomes: Higher rates of hospital visits, comorbidities, and early death.\u003c/p\u003e\n \u003cp\u003e\u0026bull; \u0026nbsp;Compared to the general population, People with ID have a higher risk of many chronic conditions (e.g., asthma, diabetes), but lower detected rates of some (e.g., cancer), possibly due to underdiagnosis.\u003c/p\u003e\n \u003cp\u003e\u0026bull; \u0026nbsp;Prevention: People with ID are often left out of screening programs; structured health assessments and inclusive care are needed.\u003c/p\u003e\n \u003cp\u003eMost data from: UK and Scandinavia; none from low-income countries(50).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Pouls, Katrien, et al (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eAdults with intellectual disabilities and mental health disorders in primary care: A scoping review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eA scoping review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eCanada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1. Social Factors in Residential Living for Adults with Intellectual Disabilities (Canada)\u003c/p\u003e\n \u003cp\u003eInclusion, autonomy, dignity, stable relationships, cultural respect, family involvement, and technology for support.\u003c/p\u003e\n \u003cp\u003e2. Chronic Illness in Primary Care \u0026ndash; Prevalence, Outcomes, Prevention\u003c/p\u003e\n \u003cp\u003eHigh prevalence (especially multimorbidity).\u003c/p\u003e\n \u003cp\u003eOutcomes: Hospitalizations, lower quality of life, early mortality.\u003c/p\u003e\n \u003cp\u003ePrevention: Screenings, lifestyle changes, patient education, tech tools.\u003c/p\u003e\n \u003cp\u003e3. How Primary Care Addresses Chronic Disease\u003c/p\u003e\n \u003cp\u003eIntegrated teams, early detection, digital health tools, self-management support, aging-at-home strategies(51).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eUsha Sambamoorthi, et al (2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cem\u003eIntellectual Disability (ID) and Chronic Conditions Burden among Adults: Insights from Harmonized Electronic Health Records\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eAdults with ID experience a higher burden of chronic conditions than those without ID.\u003c/p\u003e\n \u003cp\u003eThese disparities persist even after controlling for demographic variables.\u003c/p\u003e\n \u003cp\u003eResults highlight the need for:\u003c/p\u003e\n \u003cp\u003e\u0026middot; Better chronic disease management\u003c/p\u003e\n \u003cp\u003e\u0026middot; Improved mental health screening\u003c/p\u003e\n \u003cp\u003e\u0026middot; More tailored care in primary care and institutional settings for adults with ID(52).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Prevalence of Chronic Diseases\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea. General Burden of Chronic Conditions in Adults with ID/IDD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdults with intellectual disabilities (ID) or intellectual and developmental disabilities (IDD) experience a significantly higher prevalence of chronic diseases compared to the general population. This elevated prevalence indicates a substantial disease burden among this population, particularly in older adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb. Prevalence of Specific Chronic Conditions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eMultimorbidity\u003c/strong\u003e: Having two or more chronic conditions is significantly more common among adults with ID (adjusted odds ratio [aOR] = 1.92), with prevalence increasing with age (53).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eDiabetes Mellitus\u003c/strong\u003e: Prevalence varies widely\u0026mdash;6.6% in adults with IDD, 18.8% among autistic adults, and up to 40.35% in adults with ID only. It is more common in non-metropolitan areas (aOR \u0026asymp; 1.4) (54).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eHypertension\u003c/strong\u003e: Prevalence ranges from 15.7% in autistic individuals to over 40% in adults with ID only (55).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eHypercholesterolemia\u003c/strong\u003e: Elevated prevalence observed in adults with ID (aOR = 3.02) (56).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eThyroid Disorders\u003c/strong\u003e: Higher prevalence among individuals with ID (aOR = 4.10) (57).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eBipolar Disorder\u003c/strong\u003e: More than twice as prevalent in adults with ID (aOR = 2.09) (58).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eEpilepsy\u003c/strong\u003e: Reported prevalence ranges from 9.0% to 51.8% in adults with ID (59).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eObesity/Overweight\u003c/strong\u003e: Ranges from 3.9% to 34.8%, with higher rates in rural/small town areas (60).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eChronic Constipation\u003c/strong\u003e: Substantially higher odds observed (OR = 11.19) (61).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eAsthma\u003c/strong\u003e: Significantly more prevalent than in the general population (62).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eHeart Disease / Ischemic Heart Disease (IHD)\u003c/strong\u003e: Extremely high prevalence\u0026mdash;75% in adults with ID, 67% in those with Down syndrome, and 64% in autistic adults with ID (63).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eChronic Obstructive Pulmonary Disease (COPD)\u003c/strong\u003e: Elevated prevalence in adults with ID (Prevalence Ratio = 1.52) (64).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eAtrial Fibrillation (AF)\u003c/strong\u003e: Found more frequently following ischemic stroke (2.29%) than in hemorrhagic stroke (0.80%) or subarachnoid hemorrhage (0.70%) (66).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Health Outcomes and Gaps in Care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea. Adverse Health Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eIncreased Morbidity and Mortality\u003c/strong\u003e: Adults with ID face earlier onset of chronic conditions, higher hospitalization rates, longer ICU/hospital stays, premature mortality, and reduced life expectancy (67).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eReduced Quality of Life\u003c/strong\u003e: Greater frailty and lower overall quality of life compared to peers without ID (68).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eDiagnostic Overshadowing\u003c/strong\u003e: Conditions such as cardiovascular disease or cancer are often undiagnosed or misattributed to ID, delaying treatment and worsening outcomes (69).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eCommunication Barriers\u003c/strong\u003e: Individuals with ID frequently struggle to articulate or interpret symptoms, contributing to delays in diagnosis and treatment (70).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb. Gaps in Diagnosis and Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eLimited Access to Primary Care\u003c/strong\u003e: Preventive services and regular checkups are often lacking or inadequate for this population (71).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eLack of Tailored Care Protocols\u003c/strong\u003e: There is an urgent need for age- and condition-specific care guidelines for individuals with ID (72).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eInsufficient Provider Training\u003c/strong\u003e: Many healthcare providers lack adequate training to address the needs of adults with IDD, particularly in primary care (73).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSystemic Barriers\u003c/strong\u003e: Challenges include transportation difficulties, high care costs, poor service coordination, and provider shortages, especially in rural areas (74).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eHealth Inequities\u003c/strong\u003e: Many health disparities experienced by individuals with IDD are preventable and linked to broader social and environmental determinants (75).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec. Social Determinants of Health\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eHealth Access Inequities\u003c/strong\u003e: Disproportionate representation of Black, Hispanic, and other minority groups in the ID population necessitates culturally competent care models (76).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eUnderdiagnosis of Mental Health\u003c/strong\u003e: Depression and other mental health issues are often underrecognized, highlighting communication and social barriers to care (77).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eCaregiver and Staff Needs\u003c/strong\u003e: Effective support requires trained caregivers familiar with multimorbidity and mental health challenges in ID populations (78).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eResidential Living Arrangements\u003c/strong\u003e: Group homes may contribute to poor outcomes through limited physical activity, social isolation, and poor nutrition (79).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eGeographical Disparities\u003c/strong\u003e: Rural and small-town residents with IDD face more limited-service access and worse health outcomes than urban residents (80).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSocioeconomic Status\u003c/strong\u003e: Higher rates of poverty, polypharmacy, and inadequate nutrition are common in residential settings and influence chronic disease risks (81).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Strategies for Prevention and Management in Primary Care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea. Preventive Strategies in Primary Care Settings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eEarly Screening and Diagnosis\u003c/strong\u003e: Enhanced screening, especially for underreported conditions like depression, is essential (82).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eTailored Chronic Disease Management\u003c/strong\u003e: Management plans must be adapted to the specific needs of individuals with ID (83).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eProvider Training\u003c/strong\u003e: Training in communication techniques and diagnostic challenges associated with ID is critical (84).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eUse of Electronic Health Records (EHRs)\u003c/strong\u003e: Coordinated use of EHRs helps track disease patterns and facilitate care continuity (85).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eLifestyle Interventions\u003c/strong\u003e: Promotion of healthy diets, physical activity, and self-care through customized programs (86).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eDigital Health Tools\u003c/strong\u003e: Technologies such as telehealth, smart home devices, and sensors enable early alerts and remote monitoring (87).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eVaccinations and Risk Factor Control\u003c/strong\u003e: Routine primary care visits should include immunizations and proactive chronic disease prevention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb. Approaches to Address Prevalence and Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eIntegrated and Coordinated Care Models\u003c/strong\u003e: Multidisciplinary collaboration among GPs, nurses, social workers, and specialists is necessary to manage complex health needs (88).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eProactive Health Monitoring\u003c/strong\u003e: Use of structured screening tools like the Comprehensive Health Assessment Program (CHAP) for risk identification (89).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003ePatient Education and Counseling\u003c/strong\u003e: Empowering patients to participate in care decisions and improve treatment adherence (90).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eAging-in-Place Strategies\u003c/strong\u003e: Supporting older adults to remain in their homes with necessary services and reduced reliance on institutional care (91).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003ePriority Access to Preventive Services\u003c/strong\u003e: Ensuring inclusion in national screening programs with accessible infrastructure (92).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eStaff Training in Primary Care\u003c/strong\u003e: Training GPs and frontline staff to recognize illness in non-verbal or cognitively impaired patients (93).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eData-Driven Policy Design\u003c/strong\u003e: Leveraging insurance and public health data to design and target interventions (94).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec. Social and Systemic Strategies in Residential Settings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSocial Inclusion and Community Engagement\u003c/strong\u003e: Creating meaningful opportunities for social participation and interaction (95).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eAutonomy and Choice\u003c/strong\u003e: Empowering individuals to make decisions about daily routines and personal care (96).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eDignity and Respect\u003c/strong\u003e: Ensuring person-centered care that respects individual rights and preferences (97).\u003c/p\u003e\n\u003cp\u003eIn addition to mapping the prevalence, health outcomes, and management strategies of chronic diseases in adults with ID, this review also identified key risk factors, commonly used outcome measures, and notable gaps in the literature, which are summarized below:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk Factors Identified in People with Intellectual Disabilities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNumerous studies in this scoping review identified specific risk factors contributing to the increased burden of chronic diseases in adults with ID. These include both biomedical and social determinants:\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eBiological Risk Factors\u003c/strong\u003e: Age, sex (e.g., higher cardiovascular risk in males), and genetic syndromes such as Down syndrome or Fragile X are consistently associated with higher prevalence of certain chronic conditions (98).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eLifestyle-Related Risks\u003c/strong\u003e: Poor diet, physical inactivity, smoking, and lack of access to health education were frequently reported as contributing to the development or exacerbation of chronic illnesses (99).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003ePsychosocial Factors\u003c/strong\u003e: Social isolation, lack of autonomy, and low levels of social participation increased vulnerability to both mental and physical health problems (100).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eHealth System Factors\u003c/strong\u003e: Inadequate screening, provider bias, poor continuity of care, and insufficient follow-up contributed to missed opportunities for early prevention and intervention (101).\u003c/p\u003e\n\u003cp\u003eUnderstanding these risk factors is essential for targeting preventive strategies and improving health outcomes in this population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Outcome Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe included studies used a wide range of outcome measures to assess the impact of chronic diseases and interventions among adults with ID. These outcomes help quantify the burden and guide improvements in care:\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eClinical Outcomes\u003c/strong\u003e: Rates of hospitalization, ICU admission, complications of chronic diseases, and mortality (102).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eFunctional Outcomes\u003c/strong\u003e: Measures of mobility, activities of daily living, and frailty scores (103).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eQuality of Life Indicators\u003c/strong\u003e: Patient-reported outcomes on physical and mental health, autonomy, and social participation (104).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eHealth Service Utilization\u003c/strong\u003e: Number of GP visits, emergency care usage, and preventive service uptake (105).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003ePsychosocial Measures\u003c/strong\u003e: Levels of depression, anxiety, and social well-being as assessed by caregivers or validated tools (106).\u003c/p\u003e\n\u003cp\u003eThese diverse outcome indicators provide a more nuanced understanding of health status and care effectiveness for adults with intellectual disabilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6. Gaps and Limitations in the Literature\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite the growing body of evidence, this review highlights several gaps and limitations that hinder a comprehensive understanding of chronic disease care in adults with ID:\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eLack of Longitudinal Studies\u003c/strong\u003e: Most available studies are cross-sectional, limiting insights into causal pathways and disease progression (107).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eUnderrepresentation of Minority Populations\u003c/strong\u003e: Ethnic and racial minority groups are often excluded or underreported in the literature (108).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eInconsistent Definitions and Measures\u003c/strong\u003e: Variability in how intellectual disability and chronic diseases are defined or measured complicates comparison across studies (109).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eLimited Focus on Intervention Outcomes\u003c/strong\u003e: Few studies evaluate the effectiveness of tailored interventions or long-term management strategies in primary care (110).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eScarcity of Voices from Individuals with ID\u003c/strong\u003e: Perspectives of individuals with ID themselves are rarely included in research, limiting understanding of their priorities and lived experiences (111).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eData Gaps in Low- and Middle-Income Countries\u003c/strong\u003e: Most evidence comes from high-income settings, making it difficult to generalize findings globally (112).\u003c/p\u003e\n\u003cp\u003eAddressing these gaps is crucial to inform equitable, effective, and person-centered approaches to chronic disease prevention and management for adults with intellectual disabilities.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis scoping review synthesized evidence from a wide range of studies to provide a comprehensive understanding of the burden, management, and care-related challenges of chronic diseases in adults with intellectual disabilities (ID) or intellectual and developmental disabilities (IDD). The findings revealed a significantly higher prevalence of chronic diseases\u0026mdash;including diabetes, hypertension, cardiovascular disease, epilepsy, obesity, and chronic respiratory conditions\u0026mdash;among individuals with ID/IDD compared to the general population. Multimorbidity was common and often occurred at earlier ages, contributing to increased healthcare utilization and poorer health outcomes.\u003c/p\u003e\u003cp\u003eThe review highlighted several adverse health outcomes faced by this population, such as reduced life expectancy, premature mortality, higher hospitalization rates, and diagnostic delays due to overshadowing and communication barriers. Limited access to preventive services and primary care, lack of tailored clinical guidelines, and insufficient provider training emerged as critical gaps in care. Social determinants of health, including socioeconomic disadvantage, rural residence, inadequate nutrition, and cultural barriers, further compounded the disparities in health outcomes.\u003c/p\u003e\u003cp\u003eSeveral modifiable risk factors were identified, including lifestyle-related elements (e.g., physical inactivity, poor diet), environmental constraints (e.g., institutional living settings), and systemic healthcare barriers. These findings underscore the importance of developing comprehensive and inclusive care models that incorporate early screening, person-centered chronic disease management, and staff education. Furthermore, targeted use of digital tools, such as telehealth and electronic health records, may enhance monitoring and continuity of care.\u003c/p\u003e\u003cp\u003eDespite a growing body of literature, the review identified important gaps, including a lack of longitudinal studies, underrepresentation of certain demographic subgroups (e.g., ethnic minorities), and inconsistent use of outcome measures across studies. These limitations underscore the need for more robust research methodologies and equity-focused policy development to improve the health and well-being of adults with ID/IDD.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eImplications for Primary Care Practice\u003c/h2\u003e\u003cp\u003eThe findings of this scoping review underscore the critical role of primary care in addressing the complex health needs of adults with intellectual disabilities (ID) or intellectual and developmental disabilities (IDD). Primary care providers serve as the first point of contact and ongoing coordinators of care for this vulnerable population. However, the elevated prevalence of chronic diseases and multimorbidity, combined with communication challenges and diagnostic overshadowing, demands tailored approaches within primary care settings.\u003c/p\u003e\u003cp\u003eThere is a clear need for enhanced training and education of primary care professionals to improve their competence and confidence in managing patients with ID/IDD. This includes developing skills for effective communication, recognizing coexisting physical and mental health conditions early, and understanding the unique social determinants that affect these individuals. Implementing standardized screening tools and chronic disease management protocols adapted to the specific needs of people with ID/IDD can promote timely diagnosis and appropriate intervention.\u003c/p\u003e\u003cp\u003eMoreover, integrating multidisciplinary teams\u0026mdash;including nurses, social workers, and specialists\u0026mdash;within primary care can facilitate holistic and coordinated management. The use of digital health technologies, such as electronic health records and telehealth, presents opportunities to enhance care continuity and remote monitoring, particularly in underserved or rural areas. Finally, primary care practices must advocate for equitable access to preventive services and culturally competent care to reduce health disparities and improve overall outcomes for adults with intellectual disabilities.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eImplications for Research and Policy\u003c/h2\u003e\u003cp\u003eThis scoping review highlights significant gaps in the current evidence base regarding the health status, risk factors, and effective management strategies for adults with intellectual disabilities (ID) or intellectual and developmental disabilities (IDD). Future research should prioritize longitudinal studies to understand better the progression of chronic diseases and the impact of tailored interventions in this population. There is also a need for more inclusive research designs that actively involve individuals with ID/IDD and their caregivers to ensure the relevance and applicability of findings.\u003c/p\u003e\u003cp\u003ePolicy frameworks must recognize the unique health challenges faced by adults with ID/IDD and promote the development and implementation of comprehensive care models within primary care. Policymakers should advocate for increased funding and resources dedicated to training healthcare providers, improving access to preventive services, and addressing social determinants of health that disproportionately affect this group. Additionally, policies encouraging the integration of health and social care services can improve coordination and reduce systemic barriers.\u003c/p\u003e\u003cp\u003eData collection systems should be enhanced to capture detailed information on health outcomes and service utilization among people with intellectual disabilities, enabling data-driven policy decisions. Finally, culturally competent and equitable care approaches must be embedded in health policies to address disparities experienced by minority groups within the ID/IDD population, ensuring that all individuals receive appropriate and respectful care.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and Limitations of the Review\u003c/h2\u003e\u003cp\u003eThis scoping review offers a comprehensive synthesis of the current evidence regarding the prevalence, health outcomes, risk factors, and management strategies for chronic diseases in adults with intellectual disabilities (ID) or intellectual and developmental disabilities (IDD). A key strength of this review lies in its broad inclusion criteria, encompassing a diverse range of study designs, populations, and settings, which provides a holistic understanding of the health challenges faced by this vulnerable group. The systematic approach to data extraction and thematic synthesis ensures transparency and reproducibility, enhancing the reliability of the findings.\u003c/p\u003e\u003cp\u003eHowever, several limitations should be acknowledged. Firstly, the heterogeneity of included studies, in terms of methodology, sample size, and outcome measures, limits the ability to perform meta-analysis or draw definitive conclusions about causality or intervention effectiveness. Secondly, the reliance on published literature may introduce publication bias, potentially overlooking unpublished data or grey literature that could provide additional insights. Thirdly, many studies originated from high-income countries, which may limit the generalizability of findings to low- and middle-income settings with differing healthcare infrastructures and social determinants. Finally, language restrictions and the exclusion of non-English publications might have led to the omission of relevant studies.\u003c/p\u003e\u003cp\u003eDespite these limitations, this review provides valuable foundational knowledge to guide future research, policy, and clinical practice aimed at improving health outcomes for adults with ID/IDD.\u003c/p\u003e\u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis scoping review highlights the substantial burden of chronic diseases among adults with intellectual and developmental disabilities, revealing significant disparities in prevalence, health outcomes, and access to care compared to the general population. The findings emphasize the complexity of managing multimorbidity in this group and the critical gaps in tailored healthcare provision within primary care settings. Addressing these challenges requires integrated, multidisciplinary approaches and the development of specialized care protocols that accommodate the unique needs of individuals with ID/IDD.\u003c/p\u003e\u003cp\u003eMoreover, the review underscores the urgent need for enhanced provider training, improved health system coordination, and the incorporation of social determinants into care planning to reduce health inequities. While preventive strategies and innovative digital health tools offer promising avenues, systemic barriers and inequities must be addressed to effectively optimize health outcomes.\u003c/p\u003e\u003cp\u003eOverall, this review provides a comprehensive foundation for guiding future research, informing policy development, and enhancing clinical practice to promote equitable, person-centered care for adults with intellectual disabilities who live with chronic diseases.\u003c/p\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eRecommendations for Future Research\u003c/h2\u003e\u003cp\u003eDespite the growing body of evidence on chronic diseases in adults with intellectual and developmental disabilities, significant gaps remain that warrant further investigation. Future research should focus on longitudinal studies to better understand the progression and long-term outcomes of multimorbidity within this population. There is also a critical need for intervention studies that evaluate the effectiveness of tailored preventive and management strategies in primary care settings.\u003c/p\u003e\u003cp\u003eResearch should prioritize the development and validation of assessment tools specifically designed for individuals with ID/IDD to improve early detection and diagnosis of chronic conditions. Additionally, studies examining the impact of social determinants, including socioeconomic status, living arrangements, and geographic location, on health outcomes are crucial for informing comprehensive care models.\u003c/p\u003e\u003cp\u003eMoreover, future work must address the training needs and barriers faced by healthcare providers in delivering optimal care to this vulnerable group. Finally, inclusive research methodologies that incorporate the perspectives of adults with intellectual disabilities and their caregivers will enhance the relevance and applicability of findings, fostering patient-centered approaches in both clinical practice and policy-making.\u003c/p\u003e\u003c/div\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHacker K. The burden of chronic disease. Mayo Clinic Proceedings: Innovations, Quality \u0026amp; Outcomes. 2024 Feb 1;8(1):112-9.\u003c/li\u003e\n \u003cli\u003eJohnston KJ, Chin MH, Pollack HA. Health equity for individuals with intellectual and developmental disabilities. JAMA. 2022 Oct 25;328(16):1587-8.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. Global report on health equity for persons with disabilities. World Health Organization; 2022 Dec 2.\u003c/li\u003e\n \u003cli\u003eFairall LR, Folb N, Timmerman V, Lombard C, Steyn K, Bachmann MO, Bateman ED, Lund C, Cornick R, Faris G, Gaziano T. 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The British Journal of Psychiatry. 2016 Jan;208(s56):s1-3.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Dublin City University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intellectual disabilities, Chronic disease, Primary care, Health promotion, Evidence based practice","lastPublishedDoi":"10.21203/rs.3.rs-7552881/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7552881/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eAdults with intellectual disabilities (ID) experience higher rates of chronic diseases compared to the general population. Yet, evidence on the prevalence, risk factors, and outcomes of these conditions in primary care settings remains fragmented. This scoping review aims to map the existing literature and identify key themes related to chronic diseases among adults with ID.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eA comprehensive search was conducted across five electronic databases\u0026mdash;\u003cb\u003eEmbase, Medline, PubMed, Web of Science, and PsycINFO\u003c/b\u003e\u0026mdash;from inception to May 2024. Studies were included if they focused on the prevalence, risk factors, or outcomes of chronic diseases in adults (aged 18 or older) with intellectual disabilities and were based on primary care evidence. A total of \u003cb\u003e1,365 records\u003c/b\u003e were initially identified. After duplicate removal, screening, and full-text assessment, eligible studies were charted and thematically analyzed following the Arksey and O'Malley framework.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eThe included studies reported a high prevalence of chronic conditions such as ischemic heart disease, cerebrovascular disease, diabetes, and chronic obstructive pulmonary disease (COPD) among adults with ID. Risk factors included age, sedentary lifestyle, poor diet, comorbid mental health conditions, and limited access to tailored healthcare services. Outcomes often included reduced quality of life, increased hospitalizations, and premature mortality. Variation in diagnostic criteria, healthcare access, and recording practices across primary care settings posed challenges in data comparability.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e\u003cp\u003eAdults with intellectual disabilities face a disproportionate burden of chronic diseases, with multifactorial risk profiles and significant adverse outcomes. Primary care systems must adopt more inclusive practices, implement early screening strategies, and provide tailored interventions to reduce health disparities in this vulnerable population. Further research is needed to strengthen the evidence base and inform policy and practice.\u003c/p\u003e","manuscriptTitle":"Prevalence, Risk Factors, and Outcomes of Chronic Diseases in Adults with Intellectual Disabilities: A Scoping Review of Primary Care Evidence","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 12:24:47","doi":"10.21203/rs.3.rs-7552881/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2715bf51-e925-4c34-a720-b578e7f3fb3e","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-09T12:24:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 12:24:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7552881","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7552881","identity":"rs-7552881","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}