Causes and risk factors
Learning disability can arise from factors that affect brain development before birth, around the time of birth, or in early childhood. In many cases, causes are multifactorial, and for some people no single cause is identified. [2,19]
Genetic and chromosomal conditions contribute to learning disability in some people. Examples include Down syndrome, Fragile X syndrome, and a range of other genetic or syndromic conditions associated with neurodevelopmental impairment. [2,19] Learning disability may also co-occur with conditions such as autism, cerebral palsy or epilepsy, although this does not mean that one condition directly causes the other. [2]
Before birth, risk factors include issues that affect foetal brain development during pregnancy, such as maternal illness, exposure to alcohol or drugs, and other environmental or nutritional factors. [2,19] Around the time of birth, complications such as reduced oxygen supply to the baby during delivery can also contribute to the development of a learning disability. [2] After birth, serious early childhood illness or injury affecting the developing brain, such as meningitis or significant head injury, may also be a cause. [2,19] The impact of these factors varies according to their severity and timing.
prevention, monitoring and treatment can make a difference. [34,35]
Contributing factors and inequalities in care
PWLD may experience barriers to recognising or communicating symptoms, particularly where information is complex or services are not adapted to their needs. Difficulties obtaining accessible information and appointments and participating in shared decision-making can delay diagnosis and treatment. These barriers result from the interaction between individual communication needs and the accessibility of healthcare services, rather than learning disability alone. [2,12,16]
Health services do not always identify and record learning disability consistently. People who are not recorded on a GP learning disability register may be less likely to receive Annual Health Checks, reasonable adjustments and proactive follow-up. This is a persistent issue as an estimated 1.3 million people in England have a learning disability, but only around a quarter are represented on GP learning disability registers. [23,33] Accurate identification is therefore both a clinical and a population-health priority: individuals may otherwise miss proactive care, while commissioners may underestimate population need and inequalities. [17,18,24]
Diagnostic overshadowing remains a major cause of avoidable harm. This occurs when physical or mental health symptoms are wrongly attributed to the person’s learning disability rather than investigated as possible illness, pain or distress. As a result, diagnosis and treatment may be delayed. Risks can be compounded where care is fragmented across primary care, hospitals, community services and social care. [16,25,35]
Prescribing is another area of concern. Concerns about inappropriate psychotropic prescribing led to the NHS England programme, STOMP (Stopping Over-Medication of People with a Learning Disability, Autism or Both). Although adults with learning disabilities experience a higher burden of mental health need than the general population, prescribing rates for antipsychotic and antidepressant medication remain substantially higher. [2, 26] In 2024/25, NHS Digital found that 13.8% of patients with learning disabilities were prescribed antipsychotics compared with 0.9% of patients without learning disability, and 22.4% were prescribed antidepressants compared with 11.0% of patients without learning disability. [24] Medication reviews, clear indications, side-effect monitoring and access to non-medication support remain important. [27]
End-of-life care can also reflect wider inequalities in access to and quality of care. NHS England reported that people with learning disabilities consistently die more often in hospital than the general population, 57% compared with 43%. [23] LeDeR and related learning reports highlight ongoing concerns around discussions with patients and families, application of the Mental Capacity Act, Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions, and end-of-life discussions. These issues can directly affect access to investigations, treatment and escalation of care. [16,22,37]
Inequalities within the learning disability population
Health inequalities are not experienced uniformly within the learning disability population. Learning disability can interact with ethnicity, sex, socioeconomic disadvantage and other characteristics to create overlapping forms of marginalisation, sometimes described as double discrimination. [42] LeDeR found that, between 2021 and 2023, people from Asian and Asian British backgrounds who died had a median age at death of 43 years, around 20 years younger than people from White backgrounds. [22] Similarly, Camden’s 2022/23 LeDeR report reported that residents from Black, Asian and minority ethnic (BAME) backgrounds die at a significantly younger age than residents from other ethnic backgrounds.
Despite this substantial difference in mortality, little is known about the health status of people with intellectual disabilities from global majority ethnic groups in the UK. The available evidence suggests that they may face additional barriers to accessing specialist services and other forms of health care, but this remains an important gap in the evidence base and highlights the need for more research and better routine data on ethnicity and health outcomes within the learning disability population. [42,43]
Sex and gender may also shape health needs and experiences of care. Women with learning disabilities have lower uptake of cervical and breast screening than the general female population, and some evidence suggests that the mortality gap may be greater for women than for men. Qualitative research has identified gender-specific barriers which affect access to appropriate health information, autonomy, support and protection from harm. Furthermore, assumptions about the capabilities of women with intellectual disabilities can restrict their agency, supported decision-making and opportunities for motherhood. [2,12,24,44,45]
Social determinants of health
Health inequalities experienced by adults with learning disabilities are shaped not only by healthcare access and quality, but also by the wider social conditions in which people live. The Institute of Health Equity highlights that PWLD are more likely than the general population to experience poverty, unemployment, poor or unsuitable housing, discrimination, social exclusion and loneliness. These disadvantages can adversely affect physical health, mental health and wellbeing throughout life. [40] Inequalities cannot be addressed through healthcare services alone and require coordinated action across public health, adult social care, and community services, as well as healthcare.
Loneliness and social isolation appear particularly important determinants of health. The Institute of Health Equity estimated that around half of PWLD experience chronic loneliness, compared with approximately 15% to 30% of the general population. Loneliness is associated with poorer mental and physical health, while social exclusion may also contribute to physical inactivity and obesity. Addressing poorer health outcomes therefore requires reviewing these upstream determinants and coming up with solutions that are suitable and holistic. [40]
Employment data illustrate the extent of social and economic exclusion experienced by many adults with learning disabilities who receive long-term support. In England in 2022/23, only 4.8% were in paid employment, compared with an overall working-age employment rate of approximately 75.7%. In practical terms, this means around 1 in 21 adults receiving long-term learning disability support were in paid work, compared with approximately 3 in 4 working-age adults overall. [41]