Inequalities in cancer diagnostic outcomes for patients with a learning disability: a retrospective cohort study in England

Objectives: The cancer diagnostic process may be more complicated for patients with a learning disability ('intellectual disability' outside of the UK) than for other patients. We aimed to investigate whether patients with a learning disability were more likely to experience disadvantage in cancer diagnostic pathways and outcomes. Design: A retrospective cohort study using routinely collected linked data across primary care and cancer registration. Setting: 1470 general practices in England. Participants: 277 050 participants who were aged 40+ years, had an incident cancer recorded in the cancer registration during 2012-2018 and were registered for at least 3 years at their general practice prior to diagnosis. Main outcome measures: Emergency presentation route to diagnosis or urgent suspected cancer referral route to diagnosis, cancer stage at diagnosis (early vs advanced) and all-cause mortality within 30 days after diagnosis. Results: 277 050 patients were included in the overall study, of which 211 423 were included in analyses with cancer stage as outcome. Learning disability was recorded for 796 (0.3%) patients. Patients with a learning disability were over twice as likely to be diagnosed via an emergency presentation (adjusted OR (aOR): 2.65, 95% CI 2.26 to 3.11, p