Cancer diagnoses, referrals, and survival in people with a learning disability in the UK: a population-based, matched cohort study

Sep 29, 2026

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Background: People with a learning disability (LD) experience poorer health outcomes, yet cancer burden in this group remains insufficiently quantified. This population-based matched cohort study compared LD and general-population outcomes. Methods: Linked primary care, hospital, mortality, and cancer registry data from CPRD Aurum were used to form 180,911 LD participants matched to 3,405,467 controls, assessing urgent suspected cancer referrals, diagnoses, treatment within six months, and overall survival. Findings: LD was linked to fewer urgent referrals and diagnoses yet higher cancer-specific risks and worse prognosis.

LanguageEnglish

CategoryHealthcare

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Pages15

Reading Time38 min

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Articles Cancer diagnoses, referrals, and survival in people with a learning disability in the UK: a population-based, matched cohort study Oliver John Kennedy,a,b,∗ Umesh Chauhan,c Louise Gorman,d Paul Lorigan,a,b Samuel Merriel,e Tjeerd Van Staa,f Alison Wright,f,g and Darren Mark Ashcroftd,f aDivision of Cancer Sciences, University of Manchester, Manchester, UK bThe Christie NHS Foundation Trust, Manchester, UK cSchool of Medicine, University of Lancashire, Lancashire, UK dNational Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), The University of Manchester, Manchester, UK eCentre for Primary Care and Health Services Research, University of Manchester, Manchester, UK fCentre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK gManchester Academic Health Science Centre, Manchester, UK Summary Background People with a learning disability (LD, also known as intellectual disability) face poorer health outcomes, yet the burden of cancer in this population is poorly understood. This study investigated cancer-related outcomes in people with a LD compared to the general population. Methods A matched cohort study was conducted using linked primary care, hospital, mortality, and cancer registry data from Clinical Practice Research Datalink (CPRD) Aurum. In total, 180,911 individuals with a LD were matched with 3,405,467 controls. Outcomes included urgent suspected cancer (USC) referrals, cancer diagnoses, treatment within six months, and overall survival (OS) post-diagnosis. Findings Individuals with a LD had fewer USC referrals within 28 days of possible cancer symptoms (adjusted risk ratio [aRR] 0.52, 95% confidence interval [CI] 0.49–0.55). LD was associated with several cancers, including sarcoma (adjusted hazard ratio [aHR] 1.98, 1.65–2.39), central nervous system (aHR 3.42, 2.99–3.90), testicular (aHR 2.06, 1.61–2.62), and uterine cancers (aHR 1.69, 1.40–2.05) as well as cancer before age 50 years (aHR 1.74, 1.63–1.86) . Absolute incidence was lower in individuals with a LD compared to without (3396 [1.9%] vs 67,506 [2.0%]) due to increased all-cause mortality (aHR 3.19, 3.12–3.27) . LD was associated with fewer diagnoses via USC referrals (aRR 0.81, 0.76–0.86), fewer treatments within six months (aRR 0.83, 0.80–0.85) and shorter OS (median 4.4 years, 95% CI 3.9–5.1 vs 9.1 years, 8.8–9.5; aHR 1.73, 1.65–1.83) . Melanoma, breast, and prostate cancers were less common but had up to a fourfold increased risk of death after diagnosis in individuals with a LD. Interpretation Individuals with a LD have higher cancer risk, more diagnoses outside USC pathways, fewer treatments, and poorer prognosis. Fewer diagnoses of some cancers, alongside worse outcomes, may indicate underinvestigation. As premature all-cause mortality improves, cancer burden in this population may rise disproportionately. Funding NIHR Greater Manchester Patient Safety Research Collaboration (NIHR204295) . Copyright © 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)). Keywords: Learning disability; Intellectual disability; Cancer *Corresponding author. Division of Cancer Sciences, University of Manchester, Manchester, UK. E-mail address: [oliver.kennedy@manchester.ac.uk](oliver.kennedy@manchester.ac.uk) (O.J. Kennedy). The Lancet Regional Health - Europe 2026;60: 101519 Published Online 14 November 2025 [https://doi.org/10](https://doi.org/10) . 1016/j.lanepe.2025 . 101519 [www.thelancet.com Vol](www.thelancet.com Vol) 60 January, 2026 1 Articles Research in context Evidence before this study We searched PubMed from database inception until January 15, 2025, for relevant studies on

FAQs

What was the main goal of this study regarding learning disability and cancer?

To investigate cancer-related outcomes in people with a learning disability (LD) compared with the general population, including diagnosis, treatment, and survival.

How was the study designed and what data sources were used?

It used a matched cohort design with linked primary care, hospital, mortality, and cancer registry data from CPRD Aurum.

What key differences in cancer pathways and outcomes were observed for individuals with LD?

Individuals with LD had fewer urgent suspected cancer (USC) referrals and fewer diagnoses via USC pathways, fewer treatments within six months, and shorter overall survival after diagnosis, despite elevated risks for several cancer types.

Sep 29, 2026

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