Background: Adults with intellectual disabilities (ID) face significant barriers to screening participation. We determined predictors for regular cardiovascular health screening at baseline among adults with ID in Singapore, and evaluated the effectiveness of a 3‐month screening intervention. Methods: The study population involved all adults with ID aged ≥40 years receiving services from the Movement for the Intellectually Disabled of Singapore (MINDS), the largest such provider in Singapore. Over 3 months in 2011, adult clients not screened regularly at baseline for hypertension, diabetes and dyslipidaemia were offered free and convenient blood pressure, fasting blood glucose and lipid testing; data on other cardiovascular disease risk factors were also collected. Chi‐square and logistic regression identified predictors of regular screening at baseline. Results: Participation was 95.0% (227/239). At baseline, among adults with ID, 61.8% (118/191), 24.8% (52/210) and 18.2% (34/187) had gone for regular hypertension, diabetes and dyslipidaemia screening respectively; post intervention, rates rose to 96.9%, 89.5% and 88.8% respectively. Prevalence of cardiovascular disease risk factors (22.5% with hypertension, 10.6% with diabetes, 34.8% with dyslipidaemia, 10.7% obese and 90.6% lacking regular exercise) was high compared against the general population. While receiving residential services was associated with regular hypertension screening, receiving non‐residential services and being independently mobile were associated with regular participation in fasting blood tests (all P < 0.05). Conclusion: Cardiovascular disease risk factors are common among adults with ID and clinicians should proactively screen such populations. Provision of free and convenient screening for cardiovascular disease risk improved screening participation.
dyslipidaemia; health screening; hypertension; intellectual disabilities; diabetes
Early detection and prevention via health screening is essential in the management of chronic diseases. However, not all groups have equal access to preventive services. Adults with intellectual disabilities (ID), in particular, form a neglected group. Advances in health care that have resulted in increased longevity among the population with ID also make chronic disease management more challenging, given the growing number of middle‐aged and elderly persons in these populations (Bigby [
Little work has been done on the barriers that those with ID face in accessing preventive services. However, the consensus in the literature is that those with ID do have reduced access to health screening. In the case of cancer screening, various studies demonstrate that uptake of screening for breast cancer (Sullivan et al. [
Singapore is one such example of a multi‐ethnic Asian society. While the exact prevalence of ID among the Singaporean population is unknown, estimates from other Asian countries suggest a prevalence of less than 1.3% (Jeevanandam [
The study population involved all adult clients aged 40 years and above of MINDS. At the time of our study, MINDS had 239 clients aged ≥40 years as of 31 December 2010 who were recipients of various services; 75 clients were provided residential services, whereas 146 clients participated in its Employment Development Centres (EDCs) and 18 clients participated in its Training Development Centres (TDCs). The EDCs serve individuals who are independent in daily living skills and promote the social and economic integration of adults with ID through programmes that empower the vocational ability of their clients, whereas the TDCs serve adults with ID who require higher levels of support, and have as their focus training in activities of daily living skills, community living skills and social/recreational skills. MINDS also runs residential services that provide respite, short‐term or long‐term care for ID adults (Westerinen et al. [
Descriptive statistics were computed for the study population. We used McNemar's test to determine whether the increases in health screening take‐up for hypertension, diabetes mellitus and dyslipidaemia were significant after our 3‐month intervention. Chi‐square and logistic regression were used to identify socio‐demographic and clinical predictors of adherence to regular screening at baseline among adults with ID for bivariate and multivariate analysis respectively. The criterion for initial entry of variables into multivariate models was P < 0.2 on bivariate analysis and we presented the most parsimonious model of factors accounting for screening uptake before intervention, controlling for differences in baseline characteristics. To better understand reasons for not attending regular screening at baseline and post intervention, caregivers of clients were asked for their reasons for non‐participation in regular screening both at baseline and post intervention, where applicable, using standardised questionnaires. All statistical analysis was performed using Statistical Package for Social Sciences (spss, Version 18.0, USA) and statistical significance was set at P < 0.05.
Overall participation was 95.0% (227/239); participation rate among those receiving EDC services was 97.2% (142/146), 83.3% (15/18) among those receiving TDC services and 90.7% (68/75) among those receiving residential services. The socio‐demographic profile of participants is detailed in Table [NaN] . The median age of participants was 46 years (inter‐quartile range, IQR = 42–52). The majority (62.5%, 167/227) had a primary caregiver, defined as the main person among all potential caregivers who would actually provide physical care for the adult client. The median age of their caregivers was 66 years (IQR = 55–72). Roughly equal numbers of clients depended on their parents (46.1%, 77/167) or siblings (42.5%, 71/167) as their primary caregiver. More than half of study participants (53.2%, 142/227) were receiving services from the EDCs. The medical history and functional status of adult clients with ID are detailed in Table [NaN] . The principal diagnosis for ID was Down syndrome (27.8%, 63/227). Of note, 15.9% (36/227) of clients already had a pre‐existing history of doctor‐diagnosed hypertension, 7.5% (17/227) had a pre‐existing history of doctor‐diagnosed type II diabetes mellitus and 17.6% (40/227) had a pre‐existing history of dyslipidaemia. In addition, excluding these three diseases, 48.0% (109/227) had a history of at least one other medical condition, and none had a history of ischaemic heart disease at the time of the study. In terms of other cardiovascular disease risk factors, 4.4% (10/227) had smoked before, with 2.2% (5/227) currently smoking; only 9.4% (15/159) were exercising regularly; and none had a history of alcohol consumption. In terms of their functional status, the large majority of study participants were able to walk independently (86.3%, 196/227), although in terms of communication, only 21.1% (48/227) were fully communicative in usual verbal speech.
Socio‐demographic characteristics of adult clients (age ≥ 40 years) at the M ovement for the I ntellectually D isabled of S ingapore
Characteristics of clients (n = 227) n (%) Age (years) 40–49 146 (64.3) 50–59 71 (31.3) ≥60 10 (4.4) Gender Male 110 (48.5) Female 117 (51.5) Ethnicity Chinese 190 (83.7) Malay 10 (4.4) Indian 23 (10.1) Others 4 (1.8) Services received Employment development centre 142 (53.2) Training development centre 15 (5.6) Residential services 68 (25.5) Has primary caregiver No 60 (26.4) Yes 167 (73.5) Monthly household income ($) ≤899 56 (24.7) >900–≤2499 63 (27.8) >2500 108 (47.6)
1 Numbers do not add up to total due to missing values.
Medical history and functional status of adult clients (age ≥ 40 years) at the M ovement for the I ntellectually D isabled of S ingapore
Characteristics of clients (n = 227) n (%) Principal diagnosis for intellectual disability Down syndrome 63 (27.8) Cerebral palsy 22 (9.7) High fever 16 (7.0) Epilepsy 11 (4.8) Global developmental delay 15 (6.6) Others 19 (8.4) Unknown cause 81 (35.7) Known medical history Hypertension 36 (15.9) Diabetes mellitus 17 (7.5) Hyperlipidaemia 40 (17.6) Congenital heart disease 11 (4.8) Thyroid disease 10 (4.4) Epilepsy 24 (10.6) Asthma 5 (2.2) Dermatological condition 17 (7.5) Psychiatric diagnosis (excluding intellectual disability) 37 (16.3) Ear, nose and throat problems 8 (3.5) Eye problems 9 (4.0) Gout 4 (1.8) Gastrointestinal diseases 14 (6.2) Ischemic heart disease 0 (0.0) Lifestyle history Smoked before No 209 (92.1) Yes 10 (4.4) Ex‐smoker 5 (2.2) Current smoker 5 (2.2) Regular exercise (>20 min/day, ≥3 days a week) No 144 (63.4) Yes 83 (36.6) Alcohol consumption No 227 (100.0) Yes 0 (0.0) Mobility status Walks independently 196 (86.3) Walks with assistive devices (e.g. walking stick, frame) 11 (7.0) Wheelchair bound 16 (4.8) Immobile 4 (1.8) Communication abilities Sentences 48 (21.1) Words/phrases 88 (38.8) Non‐verbal communication (e.g. gestures) 60 (26.4) Non‐communicative in usual verbal speech 31 (13.7) Activities of daily living Feeding Feeding independently 194 (85.5) Requires assistance 18 (7.9) Fully dependent 15 (6.6) Bathing Bathing independently 146 (64.3) Requires assistance 45 (19.8) Fully dependent 36 (15.9) Dressing Dressing independently 161 (70.9) Requires assistance 35 (15.4) Fully dependent 31 (13.7) Bladder Continent 172 (75.8) Needs assistance 14 (6.2) Incontinent 41 (18.1) Bowel Continent 176 (77.5) Needs assistance 16 (7.0) Incontinent 35 (15.4)
- 2 Includes other diagnoses like head trauma, hydrocephalus, etc.
- 3 For exercise, those receiving residential services (n = 68) already receive fixed exercise periods during their stay in the residential home at least >20 min/day and ≥3 days a week, and were included in this analysis. However, if those receiving residential services were excluded, the participation rate in regular exercise would only be 9.4%.
Health screening participation rates before and after interventions are detailed in Table [NaN] . In this population of adults with ID, for hypertension screening, 61.8% of unknown hypertensives had measured their blood pressure in the past year, close to the national average of 63.9% (Ministry of Health [
Participation in cardiovascular health screening before and after intervention for hypertension, diabetes mellitus, dyslipidaemia and obesity among adult clients (age ≥ 40 years) at the M ovement for the I ntellectually D isabled of S ingapore ( n = 227)
Screening modality Number eligible for health screening as recommended Those who had gone for screening as recommended before intervention, n (%) Those who were screened at intervention, n (%) Those who had gone for screening as recommended after intervention, n (%) Those who had positive results from screening during intervention, n (%) Framingham risk score (10‐year risk of coronary artery disease) among those who were screened at intervention, n (%) Low risk (<10%) Intermediate risk (10–20%) Uncalculated Blood pressure 191 118/191 (61.8) 67/191 (35.1) 185/191 (96.9) 15/67 (22.3) 38/67 (56.7) 0/67 (0.0) 29/67 (43.3) Fasting blood glucose 210 52/210 (24.8) 136/210 (64.8) 188/210 (89.5) 7/136 (5.14) 84/136 (61.8) 1/136 (0.7) 51/136 (37.5) Fasting blood lipids 187 34/187 (18.2) 132/187 (70.6) 166/187 (88.8) 39/132 (29.5) 83/132 (62.9) 1/132 (0.8) 48/132 (36.4) Body mass index (BMI) 227 NA 183/227 (80.6) 183/227 (80.6) 99/183 (54.0) 97/183 (53.0) 2/183 (1.1) 84/183 (45.9)
- 4 Based on MOH Clinical Practice Guidelines for Health Screening: for those aged ≥40, blood pressure every year, fasting glucose and lipids every 3 years. Clients were encouraged to go for the relevant health screenings if they had not adhered to this screening regimen previously.
- 5 Positive results defined as: for blood pressure, an average systolic blood pressure of ≥140 mmHg and/or an average diastolic blood pressure of ≥90 mmHg; for fasting blood glucose, a value of ≥7.0 mmol/L; for fasting blood lipid, a total cholesterol of ≥6.2 mmol/L and/or a triglyceride of ≥2.3 mmol/L and/or an HDL <1.0 mmol/L and/or an LDL ≥4.1 mmol/L. Overweight was defined as BMI ≥23 kg/m2, as per our local Health Promotion Board.
- 6 Framingham risk score was calculated using risk score tables derived from the Framingham‐based NCEP‐ATPIII 10‐Year Risk Score Tables, which were modified taking into account Singapore cardiovascular epidemiological data, provided by the Singapore Ministry of Health, Singapore General Hospital, National University of Singapore and Prof. Ralph B D'Agostino from the Framingham Heart Study, USA (Ministry of Health, Singapore 23). As ethnicity‐specific risk score tables were only available for Chinese, Malay and Indian ethnicities, those of other ethnicities were compared against the risk score table for majority (Chinese) ethnicity.
- 7 Not calculated because one or more components of the Framingham risk score were not available for computation for these individuals.
The factors associated with not going for regular screening for hypertension, diabetes and dyslipidaemia at baseline in this population of adults with ID are listed in Tables [NaN] (univariate analysis) and [NaN] (multivariate analysis). At baseline, being of non‐Chinese (minority) ethnicity (adjusted odds ratio, aOR = 5.88, 95% CI = 1.92–16.67, P = 0.002), receiving residential services (aOR = 83.98, 95% CI = 10.94–644.76, P < 0.001), having a history of dyslipidaemia (aOR = 13.07, 95% CI = 3.14–54.33, P < 0.001), a history of epilepsy (aOR = 5.95, 95% CI = 1.04–34.20, P = 0.046) and being partially/non‐communicative in usual verbal speech (aOR = 4.17, 95% CI = 1.54–12.5, P = 0.005) were independently associated with going for regular hypertension screening; other cardiovascular disease risk factors such as smoking and physical inactivity were not independently associated with going for regular hypertension screening at baseline. Having a history of hypertension (aOR = 6.68, 95% CI = 2.26–19.77, P = 0.001) and a history of dyslipidaemia (aOR = 5.29, 95% CI = 1.85–15.15, P = 0.002) were independently associated with going for regular diabetes screening at baseline; whereas being of majority (Chinese) ethnicity (aOR = 0.12, 95% CI = 0.04–0.33, P < 0.001), receiving residential services (aOR = 0.04, 95% CI = 0.01–0.21, P < 0.001) and a monthly household income of $900–2499 (vs. a monthly household income of <$899) (aOR = 0.21, 95% CI = 0.07–0.67, P = 0.008) were independently associated with not going for regular diabetes screening. Having a history of hypertension (aOR = 24.64, 95% CI = 6.24–97.32, P < 0.001) and being independently mobile (aOR = 10.95, 95% CI = 1.02–117.39, P = 0.048) were independently associated with going for regular dyslipidaemia screening at baseline, whereas being of majority (Chinese) ethnicity (aOR = 0.28, 95% CI = 0.11–0.76, P = 0.012) and having a previous psychiatric diagnosis (aOR = 0.15, 95% CI = 0.02–0.88, P = 0.036) were associated with not participating in regular dyslipidaemia screening. Smoking and physical inactivity were not independently associated with participation in diabetes and dyslipidaemia screening.
Bivariate associations with going for regular hypertension, diabetes and dyslipidaemia screening at baseline among adult clients (age ≥ 40 years) at the M ovement for the I ntellectually D isabled of S ingapore ( n = 227)
Factors Regularly screened for hypertension via blood pressure measurement (n = 191) Regularly screened for diabetes mellitus via fasting blood glucose test (n = 210) Regularly screened for dyslipidaemia via fasting blood lipids test (n = 187) No, n (%) Yes, n (%) Crude OR (95% CI) P‐value No, n (%) Yes, n (%) Crude OR (95% CI) P‐value No, n (%) Yes, n (%) Crude OR (95% CI) P‐value Socio‐demographic characteristics Age (years) 40–49 56 (43.8) 72 (56.3) 1.00 0.027 101 (73.7) 36 (26.3) 1.00 0.508 99 (83.2) 20 (16.8) 1.00 0.557 ≥50 17 (27.0) 46 (73.0) 2.11 (1.09–4.06) 57 (78.1) 16 (21.9) 0.79 (0.40–1.54) 54 (79.4) 14 (20.6) 1.28 (0.60–2.74) Gender Female 43 (45.3) 52 (54.7) 1.00 0.054 74 (74.0) 26 (26.0) 1.00 0.750 75 (83.3) 15 (16.7) 1.00 0.705 Male 30 (31.3) 66 (68.8) 1.82 (1.01–3.29) 84 (76.4) 26 (23.6) 0.88 (0.47–1.65) 78 (80.4) 19 (19.6) 1.22 (0.58–2.57) Ethnicity Non‐Chinese 6 (18.8) 26 (81.3) 1.00 0.016 16 (47.1) 18 (52.9) 1.00 <0.001 19 (63.3) 11 (36.7) 1.00 0.008 Chinese 67 (42.1) 92 (57.9) 0.32 (0.21–0.94) 142 (80.7) 34 (19.3) 0.21 (0.10–0.46) 134 (85.4) 23 (14.6) 0.30 (0.13–0.70) Services received Non‐residential 72 (57.1) 54 (42.9) 1.00 <0.001 96 (66.2) 49 (33.8) 1.00 <0.001 97 (76.4) 30 (23.6) 1.00 0.002 Residential 1 (1.6) 63 (98.4) 84.00 (11.29–624.87) 62 (96.9) 2 (3.1) 0.06 (0.02–0.27) 56 (94.9) 3 (5.1) 0.17 (0.05–0.59) Has caregiver No 10 (20.4) 39 (79.6) 1.00 0.004 43 (76.8) 13 (23.2) 1.00 0.857 38 (77.6) 11 (22.4) 1.00 0.392 Yes 63 (44.4) 79 (55.6) 0.32 (0.15–0.69) 115 (74.7) 39 (25.3) 1.12 (0.55–2.30) 115 (83.3) 23 (16.7) 0.69 (0.31–1.55) Monthly household income ($) <899 22 (45.8) 26 (54.2) 1.00 38 (71.7) 15 (28.3) 1.00 37 (84.1) 7 (15.9) 1.00 >900–<2499 20 (40.8) 29 (59.2) 1.23 (0.55–2.74) 0.136 48 (85.7) 8 (14.3) 0.42 (0.16–1.10) 0.078 44 (86.3) 7 (13.7) 0.84 (0.27–2.62) 0.765 >2500 31 (33.0) 63 (67.0) 1.72 (0.84–3.51) 0.618 72 (71.3) 29 (28.7) 1.02 (0.49–2.13) 0.957 72 (78.3) 20 (21.7) 1.47 (0.57–3.79) 0.427 Lifestyle factors Smoked before No 69 (37.5) 115 (62.5) 1.00 0.431 154 (76.2) 48 (23.8) 1.00 0.106 150 (82.9) 31 (17.1) 1.00 0.075 Yes 4 (57.1) 3 (42.9) 0.45 (0.10–2.07) 4 (50.0) 4 (50.0) 3.20 (0.77–13.32) 3 (50.0) 3 (50.0) 4.83 (0.93–25.10) Regular exercise No 64 (56.1) 50 (43.9) 1.00 0.775 87 (65.9) 45 (34.1) 1.00 1.00 86 (74.8) 29(25.2) 1.00 0.521 Yes 8 (61.5) 5 (38.5) 0.80 (0.25–2.60) 9 (64.3) 5 (35.7) 1.07 (0.33–3.40) 11 (84.6) 2 (15.4) 0.54 (0.11–2.58) Medical history Hypertension No NA 148 (80.4) 36 (19.6) 1.00 <0.001 146 (86.9) 22 (13.1) 1.00 <0.001 Yes 10 (38.5) 16 (61.5) 6.58 (2.76–15.70) 7 (36.8) 12 (63.2) 11.37 (4.04–32.01) Diabetes mellitus No 73 (39.7) 111 (60.3) NC 0.045 NA 151 (82.1) 33 (17.9) 1.00 0.454 Yes 0 (0.0) 7 (100.0) 2 (66.7) 1 (33.3) 2.30 (0.20–25.98) Dyslipidaemia No 70 (41.7) 98 (58.3) 1.00 0.010 146 (79.3) 38 (20.7) 1.00 <0.001 NA Yes 3 (13.0) 20 (87.0) 4.76 (1.36–16.65) 12 (46.2) 14 (53.8) 4.48 (1.92–10.48) Psychiatric diagnosis No 68 (42.8) 91 (57.2) 1.00 0.005 126 (72.4) 48 (27.6) 1.00 0.054 123 (79.4) 32 (20.6) 1.00 0.076 Yes 5 (15.6) 27 (84.4) 4.01 (1.48–11.02) 32 (88.9) 4 (11.1) 0.33 (0.11–0.98) 30 (93.8) 2 (6.3) 0.26 (0.06–1.13) Epilepsy No 71 (41.5) 100 (58.5) 1.00 0.006 141 (74.6) 48 (25.4) 1.00 0.606 136 (81.4) 31 (18.6) 1.00 1.00 Yes 2 (100.0) 18 (90.0) 6.39 (1.44–28.42) 17 (81.0) 4 (19.0) 0.69 (0.22–2.16) 17 (85.0) 3 (15.0) 0.77 (0.21–2.81) Dermatological condition No 68 (38.6) 108 (61.4) 1.00 0.787 145 (75.1) 48 (24.9) 1.00 1.00 140 (81.9) 31 (18.1) 1.00 1.00 Yes 5 (33.3) 10 (66.7) 1.26 (0.41–3.84) 13 (76.5) 4 (23.5) 0.93 (0.29–2.99) 13 (81.3) 3 (18.8) 1.04 (0.28–3.88) Functional status Mobility Dependent 0 (0.0) 27 (100.0) 1.00 <0.001 27 (90.0) 3 (10.0) 1.00 0.065 24 (96.0) 1 (4.0) 1.00 0.052 Independent 73 (44.5) 91 (55.5) 1.80 (1.57–2.07) 131 (72.8) 49 (27.2) 3.37 (0.98–11.60) 129 (79.6) 33 (20.4) 6.14 (0.80–47.06) Communication Partially/non‐communicative 46 (30.3) 106 (69.7) 1.00 <0.001 126 (76.4) 39 (23.6) 1.00 0.559 119 (81.0) 28 (19.0) 1.00 0.649 Fully communicative 27 (69.2) 12 (30.8) 0.19 (0.09–0.41) 32 (71.1) 13 (28.9) 1.31 (0.63–2.75) 34 (85.0) 6 (15.0) 0.75 (0.29–1.96) Feeding Dependent 2 (6.5) 29 (93.5) 1.00 <0.001 28 (90.3) 3 (9.7) 1.00 0.041 25 (89.3) 3 (10.7) 1.00 0.424 Independent 71 (44.4) 89 (55.6) 0.09 (0.02–0.375) 130 (72.6) 49 (27.4) 3.52 (1.02–12.10) 128 (80.5) 31 (19.5) 2.01 (0.57–7.12) Bathing Dependent 9 (11.8) 67 (88.2) 1.00 <0.001 68 (88.3) 9 (11.7) 1.00 <0.001 65 (91.5) 6 (8.5) 1.00 0.006 Independent 64 (55.7) 51 (44.3) 0.11 (0.05–0.24) 90 (67.7) 43 (32.3) 3.61 (1.65–7.91) 88 (75.9) 28 (24.1) 3.45 (1.35–8.81) Dressing Dependent 5 (8.2) 56 (91.8) 1.00 <0.001 55 (87.3) 8 (12.7) 1.00 0.009 52 (89.7) 6 (10.3) 1.00 0.068 Independent 68 (52.3) 62 (47.7) 0.08 (0.03–0.22) 103 (70.1) 44 (29.9) 2.94 (1.29–6.68) 101 (78.3) 28 (21.7) 2.40 (0.94–6.17) Bladder Dependent 4 (7.7) 48 (92.3) 1.00 <0.001 44 (84.6) 8 (15.4) 1.00 0.095 42 (87.5) 6 (12.5) 1.00 0.283 Independent (continent) 69 (49.6) 70 (50.4) 0.09 (0.03–0.25) 114 (72.2) 44 (27.8) 2.12 (0.93–4.87) 111 (79.9) 28 (20.1) 1.77 (0.68–4.57) Bowel Dependent 1 (2.1) 47 (97.9) 1.00 <0.001 42 (84.0) 8 (16.0) 1.00 0.133 41 (87.2) 6 (12.8) 1.00 0.382 Independent (continent) 72 (50.3) 71 (49.7) 0.02 (0.003–0.16) 116 (72.5) 44 (27.5) 1.99 (0.87–4.58) 112 (80.0) 28 (20.0) 1.71 (0.66–4.42)
8 NA, not applicable; NC, could not be calculated because of a zero value in one cell.
Independent factors associated with going for regular hypertension, diabetes and dyslipidaemia screening at baseline among adult clients (age ≥ 40 years) at the M ovement for the I ntellectually D isabled of S ingapore ( n = 227)
Factors Adjusted OR (95% CI) P‐value Hypertension screening Chinese (vs. non‐Chinese) 0.17 (0.06–0.52) 0.002 Recipient of residential services (vs. resident of non‐rental services) 83.98 (10.94–644.76) <0.001 History of high cholesterol (vs. none) 13.07 (3.14–54.33) <0.001 History of epilepsy (vs. none) 5.95 (1.04–34.20) 0.046 Fully communicative (vs. partial or non‐communicative) 0.24 (0.08–0.65) 0.005 Diabetes screening Chinese (vs. non‐Chinese) 0.12 (0.04–0.33) <0.001 Recipient of residential services (vs. resident of non‐rental services) 0.04 (0.01–0.21) <0.001 Monthly household income >$900–<$2499 (vs. monthly household income <$899) 0.21 (0.07–0.67) 0.008 Monthly household income >$2500 (vs. monthly household income <$899) 1.78 (0.71–4.46) 0.217 History of hypertension (vs. none) 6.68 (2.26–19.77) 0.001 History of high cholesterol (vs. none) 5.29 (1.85–15.15) 0.002 Dyslipidaemia screening Chinese (vs. non‐Chinese) 0.28 (0.11–0.76) 0.012 History of hypertension (vs. none) 24.64 (6.24–97.32) <0.001 History of psychiatric diagnosis (vs. none) 0.15 (0.02–0.88) 0.036 Independently mobile (vs. not independently mobile) 10.95 (1.02–117.39) 0.048
9 Most parsimonious model presented. Odds ratio (ORs) reported are adjusted for all variables presented in model.
The top barriers to regular health screening in each of the three modalities at baseline before provision of free, access‐enhanced health screening are detailed in Table [NaN] . For hypertension screening, at baseline, of the 73 patients who were not being screened regularly, 31.5% had caregivers with the misperception that screening was unnecessary as the patient was not at risk, 23.3% were unaware of the need to screen and 16.4% either were too busy to bring the patient or felt that screening was inconvenient. For diabetes and dyslipidaemia screening, at baseline, the main reason for lack of regular screening was also the misperception that screening was unnecessary as the patient was not at risk; other important reasons also included the lack of a caregiver, the lack of awareness about screening and pain/discomfort experienced by the patient during the procedure.
Reasons for not participating in regular hypertension, diabetes and dyslipidaemia screening at baseline among adult clients (age ≥ 40 years) at the M ovement for the I ntellectually D isabled of S ingapore ( n = 227)
Reasons for not participating in health screening at baseline Blood pressure, n (%) Fasting blood glucose, n (%) Fasting lipid, n (%) n 73 158 153 Cost Cost of screening test too expensive 4/73 (5.5) 0 (0.0) 2/153 (1.3) Cost of further treatment, if screening is positive, too expensive 3/73 (4.1) 3/158 (1.9) 3/153 (2.0) Misperceptions Not necessary as patient is healthy/not at risk 23/73 (31.5)1 100/158 (63.3)1 89/153 (58.2)1 Screening is not important 2/73 (2.7) 0/158 (0.0) 3/153 (2.0) Lack of time Too busy to go/no time 12/73 (16.4)3 3/158 (1.9) 7/153 (4.6) Inconvenience Screening is inconvenient 12/73 (16.4)3 8/158 (5.1) 8/153 (5.2) Do not have a caregiver to go with 7/73 (9.6) 10/158 (6.3)3 9/153 (5.9)3 Lack of awareness Did not know that have to screen 17/73 (23.3)2 12/158 (7.6)2 11/153 (7.2)2 Do not know where to go for screening 3/73 (4.1) 2/158 (1.3) 2/153 (1.3) Fear Painful test 3/73 (4.1) 10/158 (6.3)3 9/153 (5.9)3 Afraid of knowing results 1/73 (1.4) 0/158 (0.0) 1/153 (0.7)
10 The superscript numbers are the top three groups of reasons for not going for regular screening for each health screening modality.
At baseline, 15.8% (36/227) of adults with ID had hypertension; post screening, this rose to 22.5% (51/227). For diabetes, 7.5% (17/227) were known cases at baseline; post screening, this rose to 10.6% (24/227). For dyslipidaemia, 17.6% (40/227) had a history at baseline; post screening, 34.8% (79/227) had dyslipidaemia. Compared against national data, where in the 40–49 age bracket, 16.7% had hypertension, 12.1% had diabetes and 18.0% had dyslipidaemia (Ministry of Health, Singapore [
The prevalence of overweight was remarkably high (54.1%) among adults with ID, compared with the national average of 25.6% among adults over 40 years in 2004 (Ministry of Health, Singapore [
Although participation in hypertension screening was similar to that of the general population, health screening for other cardiovascular disease risk factors (diabetes, and dyslipidaemia) was much lower among adults with ID in urbanised Singapore, when compared against national data (Ministry of Health, Singapore [
Our study has its limitations. To begin with, although the population in our study was drawn from a mix of both residential and non‐residential adults with ID, they were all receiving community support (in the form of services from the voluntary welfare organisation, MINDS) at the time of the study. Hence, they may be more highly cared for than other unsupported adults with ID, a factor that could indicate a healthier lifestyle and reduced cardiovascular disease risk factors, as well as greater participation in preventive services. Hence, the health profile of adults with ID in this sample may be an overestimate; we note, however, that other studies comparing the health profile of clinic‐based and population‐wide samples of adults with ID have shown no differences (Beange et al. [
In conclusion, screening rates for cardiovascular disease risk factors such as diabetes and dyslipidaemia were poor among adults with ID in Singapore. We tend to think of those with ID as young persons when in reality, they are becoming older persons in Singapore because of better paediatric and adult health care, contributing to longer life expectancies. Although the general cardiovascular disease risk of the study sample was still low, due in part to the relatively younger age (median of 46 years), the prevalence of cardiovascular disease risk factors among those checked (22.5% with hypertension, 10.6% with diabetes, 34.8% with dyslipidaemia, 54.1% overweight or obese, 10.7% obese, 90.6% of non‐residential MINDS clients lacking regular exercise) is still high, when compared against the general population. Clinicians providing care to adults with ID should thus have a low threshold for initiating screening for cardiovascular disease risk factors and ensure follow‐up for those diagnosed, and adults with ID should be supported by programmes to increase physical activity and reduce weight, with the assistance of their carers and professionals. Provision of free and convenient screening significantly increased participation in hypertension, diabetes mellitus and dyslipidaemia screening among adults with ID; however, more can be done to increase awareness among caregivers regarding the need and benefits of regular screening in this population with special needs.
None reported. The authors declare no conflict of interest.
The Movement for the Intellectually Disabled of Singapore provided funding support for arranging for screening tests for the patients involved in this study.
We thank the Movement for the Intellectually Disabled of Singapore for their assistance in the organisation of this programme and their support of this study.
By L. E. Wee; G. C‐H. Koh; L. S. Auyong; A. Cheong; T. T. Myo; J. Lin; E. Lim; S. Tan; S. Sundaramurthy; C. W. Koh; P. Ramakrishnan; R. Aariyapillai‐Rajagopal; H. Vaidynathan‐Selvamuthu and K. Ma‐Ma