Abstract
BACKGROUND: People with intellectual disability (ID) face considerable health disparities, with cancer being among the most frequent causes of premature death. A systematic analysis of the health care situation is necessary to further strengthen treatment and support for this highly vulnerable population. PATIENTS AND METHODS: In this cross-sectional study we analysed nationwide German outpatient health insurance data of 437 802 people with ID, which were compared to an age-, sex-, and district code-matched sample of people without ID. RESULTS: Overall, people with ID (4.2% with cancer) showed lower odds ratios for a cancer diagnosis compared with the matched cohort without ID (5.1% with cancer) [C00-C97: odds ratio 0.83; 95% confidence interval 0.82-0.84; P < 0.0001]. Neoplasms of skin, gastrointestinal tract, and genital organs were most prevalent. People with ID less often attended cancer screening programs (OR 0.74; 0.74-0.75; P < 0.0001). Neoplasms of the brain, testicles, ovary, uterine body, and myeloid leukaemia occurred more often in people with ID (all P < 0.0001), while skin neoplasms, prostate cancer, tumours of the respiratory system, and breast cancer occurred less often (all P < 0.0001). People with ID and cancer were less often treated by specialists than matched controls. CONCLUSIONS: Difficulties in accessing the health care system and lower cancer screening rates may contribute to fewer cancer diagnoses. Our findings highlight specific cancer types-notably brain cancer, leukaemia, testicular and ovarian tumours-that show higher prevalence in individuals with ID compared with individuals without ID. These data underscore the increased vulnerability of the ID population to these particular malignancies, guiding future research, patient care, and screening efforts.