ArticleBMJ open2026
Temporal associations between incident physical health problems/sensory impairments and challenging behaviours in people with intellectual disabilities: a population-based longitudinal cohort study of primary care in England.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo determine whether the onset of physical health problems/sensory impairments is associated with incident challenging behaviours.
designA retrospective, population-based cohort study using longitudinal data from primary care records. HRs were estimated using Cox proportional hazards models accounting for recurrent events and time-varying exposures.
settingUK primary care data sourced from the Clinical Practice Research Datalink (CPRD) Aurum and Gold databases, covering over 850 000 person-years between 2009 and 2019.
participants166 989 individuals with recorded intellectual disabilities were included in the cohort. PRIMARY OUTCOME MEASURES: Incident identification of challenging behaviours before or after a recorded incident of physical health problems/sensory impairment. Physical health problems/sensory impairments assessed included constipation, epilepsy, pain, visual impairment, hearing impairment, bowel incontinence, urinary incontinence and sleep problems.
results21.21% (n=35 415) of the cohort had challenging behaviour recorded at least once in primary care records over the 11-year study period, equating to an incidence rate of 0.10 per person-year. 40.9% of episodes of challenging behaviour were associated with an incident physical health problem/sensory impairment. All eight physical health problems/sensory impairments were significantly associated with higher HRs for challenging behaviours after full adjustment for demographic and mental health covariates. These associations held across multiple sensitivity analyses. The strongest associations were found for bowel incontinence (HR=2.24; 95% CI 2.01 to 2.50), urinary incontinence (HR=1.93; 95% CI 1.77 to 2.11), constipation (HR=1.89; 95% CI 1.74 to 2.05) and sleep problems (HR=1.74; 95% CI 1.58 to 1.90).
conclusionsThis is the first longitudinal study to establish a temporal association between the onset of physical health problems/sensory impairments and challenging behaviours in people with intellectual disabilities. These findings highlight the need for proactive identification and management of physical health problems/sensory impairments as part of assessment processes to prevent or reduce the impact of challenging behaviours.
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