Cause of death in adults with Down syndrome in the United States

Background: Prior studies report anomalous cause of death patterns for adults with Down syndrome, but do not provide comparison of age trends for specific causes of death between adults with and without Down syndrome, or explore biological sex and racial-ethnic differences in causes of death among adults with Down syndrome. Objective: To better understand cause of death trends for adults, age 18 and over, with Down syndrome. Methods: Cross-sectional data were from the 2013–2017 US Multiple Cause of Death Mortality files. Adjusted odds ratios were utilized to compare cause of death trends overall, and by age, between adults with (N = 9870) and without (N = 13,323,001) Down syndrome. We also analyzed biological sex and race-ethnic differences in cause of death solely among adults with Down syndrome. Results: Although heart disease, dementia and Alzheimer's disease, and cancer were common among adults all adults, death from these diseases was more prominent at younger ages for adults with Down syndrome. Adults with Down syndrome were also more likely to die from influenza and pneumonia, pneumonitis, respiratory failure, and choking at all ages. Distinct biological sex and racial-ethnic differences were present in causes of death among adults with Down syndrome. Conclusions: While efforts to reduce premature mortality for adults with Down syndrome should attend to common risk factors such as heart disease, dementia and Alzheimer's disease, and cancer, it is imperative to afford increased attention to earlier onset of these diseases, as well as increased risk of death from respiratory and swallowing/choking related disorders at all ages.