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Background: People with intellectual disability (ID) were identified by the Public Health Agency of Sweden as a risk group for Covid-19. At the same time, they have been found to experience barriers to health care, and the invasive testing for Covid-19 may be particularly frightening for people with limited cognitive understanding.

Methods: Register data on diagnoses in primary, specialist and hospital care was obtained for all people living in Skåne 2014 and alive in 2020. A total of 8 569 people had at least one diagnosis of ID (F7) without concomitant diagnosis of Down syndrome (DS; Q90), 3903 people with mild ID, 944 with moderate ID, 382 with severe ID, 197 with profound ID, 120 with unknown ID, and 3481 with unknown severity of ID remained. The reference cohort comprised all people in Skåne without a diagnosis of ID or DS (n=1 194 755). People with diagnosis of Covid-19 determined by laboratory test (U07.1) or clinically (U07.2) were identified. After excluding people who died prior to 2020 (459 and 70 579, respectively), the ID cohort comprised 8569 people and the referent cohort 1 194 755 people. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated using generalized linear models, adjusted for sex, year of birth, and Swedish ethnicity.

Results: People in the ID cohort were more likely than those in the referent cohort to have had at least one diagnosis of Covid-19, regardless of if this was determined by a laboratory test or not (20% vs 12%; RR 1.075, 95% CI 1.065-1.085). The effect was larger in the older population than among children and adolescents. Among those with a Covid-19-diagnosis, people with ID were more likely to have a diagnosis that was not based on a laboratory test (54% vs 24%; RR 1.378, 95% CI 1.332-1.426).

Discussion: Even though a lot of social activities for people with ID were limited or cancelled due to the Covid-19 pandemic, Covid-19 was more common in this group than in the general population.

Conclusion: Stronger measures could have been taken to protect people with ID from exposure to Covid-19.