<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>To assess the association between learning disability and risk of hospitalisation and mortality from COVID-19 in England among adults and children.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Working on behalf of NHS England, two cohort studies using patient-level data for >17 million people from primary care electronic health records were linked with death data from the Office for National Statistics and hospitalization data from NHS Secondary Uses Service using the OpenSAFELY platform.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>General practices in England which use TPP software.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Participants were males and females, aged up to 105 years, from two cohorts: (1) wave 1, registered with a TPP practice as of 1<jats:sup>st</jats:sup> March 2020 and followed until 31<jats:sup>st</jats:sup> August, 2020; (2) wave 2 registered 1<jats:sup>st</jats:sup> September 2020 and followed until 31<jats:sup>st</jats:sup> December 2020 (for admissions) or 8<jats:sup>th</jats:sup> February 2021 (for deaths). The main exposure group was people included on a general practice learning disability register (LDR), with a subgroup of people classified as having profound or severe learning disability. We also identified patients with Down syndrome and cerebral palsy (whether or not on the learning disability register).</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>(i) COVID-19 related death, (ii) COVID-19 related hospitalisation. Non-COVID-19 related death was also explored.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In wave 1, of 14,301,415 included individuals aged 16 and over, 90,095 (0.63%) were identified as being on the LDR. 30,173 COVID-related hospital admissions, 13,919 COVID-19 related deaths and 69,803 non-COVID deaths occurred; of which 538 (1.8%), 221 (1.6%) and 596 (0.85%) were among individuals on the LDR, respectively. In wave 2, 27,611 COVID-related hospital admissions, 17,933 COVID-19 related deaths and 54,171 non-COVID deaths occurred; of which 383 (1.4%), 260 (1.4%) and 470 (0.87%) were among individuals on the LDR. Wave 1 hazard ratios for individuals on the LDR, adjusted for age, sex, ethnicity and geographical location, were 5.3 (95% confidence interval (CI) 4.9, 5.8) for COVID-19 related hospital admissions and 8.2 (95% CI: 7.1, 9.4) for COVID-19 related death. Wave 2 produced similar estimates. Associations were stronger among those classed as severe-profound and among those in residential care. Down syndrome and cerebral palsy were associated with increased hazard of both events in both waves; Down syndrome to a much greater extent. Hazards of non-COVID-19 related death followed similar patterns with weaker associations.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>People with learning disabilities have markedly increased risks of hospitalisation and mortality from COVID-19. This raised risk is over and above that seen for non-COVID causes of death. Ensuring prompt access to Covid-19 testing and health care and consideration of prioritisation for COVID-19 vaccination and other targeted preventive measures are warranted.</jats:p></jats:sec>
