We compared risk factor-adjusted mortality for California adults with developmental disabilities based on 22,576 adults receiving services in California, 1985–1994. Mortality rates were adjusted for factors such as age and level of functioning. Risk factor-adjusted mortality was 72% higher in community care than in institutions. The mortality pattern over the years 1993–1994, which had not previously been studied, was comparable to that of 1985–1992. The substantially increased risk in community care suggests that community settings may be less effective in preventing mortality in this population.

The present work was supported in part by Grants No. HD21056 and HD22953 from the National Institute of Child Health and Human Development. Provision of data from the California Departments of Developmental Services and Health Services is gratefully acknowledged. The authors thank the editor and six anonymous reviewers for their thorough and thoughtful reviews. They also thank Richard Eyman and Kevin Walsh for helpful comments.

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