Deinstitutionalization in California: Mortality of Persons with Developmental Disabilities after Transfer into Community Care, 1997-1999

More than 2,000 persons with developmental disability trans- ferred from California institutions into community care during 1993 to early 1996. Using data on 1,878 children and adults moved between April 1, 1993 and March 5, 1996, Strauss, Shavelle, Baumeister and Anderson (1998) found a corresponding increase in mortality rates by comparison with those who stayed behind. Shavelle and Strauss (1999) updated the study through 1996 and found similar results. The present study is a further update through 1999. There were 81 deaths, a 47% increase in risk-adjusted mor- tality over that expected in institutions ( p< 0.01). As in the two previous studies, we found that persons transferred later were at higher risk than those moving earlier, even after adjustment for differences in risk profiles. The difference cannot be explained by the short-term effects of the transfer, and therefore appear to reflect an increased mortality rate associated with the less intensive medical care and supervision available in the community.