ObjectivesTo compare somatic healthcare usage among older people with intellectual disabilities (ID) to that of their age-peers in the general population, taking into account health and demographic factors, and to identify predictors for somatic healthcare usage among older people with ID.ParticipantsEqually sized cohorts, one with people with ID and one referent cohort, one-to-one-matched by sex and year of birth, were created. Each cohort comprised 7936 people aged 55+ years at the end of 2012.DesignRetrospective register-based study.SettingAll specialist inpatient and outpatient healthcare clinics in Sweden.Outcome measuresData regarding planned/unplanned and inpatient/outpatient specialist healthcare were collected from the Swedish National Patient Register for 2002–2012. Diagnoses, previous healthcare usage, sex, age and cohort affiliation was used to investigate potential impact on healthcare usage.ResultsCompared with the referent cohort, the ID cohort were more likely to have unplanned inpatient and outpatient care but less likely to have planned outpatient care. Within the ID cohort, sex, age and previous use of healthcare predicted healthcare usage.ConclusionsOlder people with ID seem to have lower risks of planned outpatient care compared with the general population that could not be explained by diagnoses. Potential explanations are that people with ID suffer from communication difficulties and experience the healthcare environment as unfriendly. Moreover, healthcare staff lack knowledge about the particular needs of people with ID. Altogether, this may lead to people with ID being exposed to discrimination. Although these problems are known, few interventions have been evaluated, especially related to planned outpatient care.