Health Disparities
CAUSE-SPECIFIC MORTALITY IN PEOPLE WITH AUTISM SPECTRUM DISORDER, UNITED STATES, 1999-2021 Guohua Li* Guohua Li Caleb H. Ing Zhixin Yang Ashley Blanchard Carolyn G. DiGuiseppi
Previous research suggests that people with autism spectrum disorder (ASD) are at a substantially increased risk of death compared to the general population. Little is known about the contributions of specific diseases to the excess mortality in people with ASD. This study aimed to assess major causes of death in people with ASD. We identified individuals with ASD (based on the International Classification of Diseases, 10th Revision, code F84.0) who died between 1999 and 2021 and were recorded in the multiple cause-of-death data files of the National Vital Statistics System. We calculated age-and sex-adjusted cause-specific proportionate mortality ratios (PMRs) and 95% confidence intervals (CIs) using 2010 mortality data for the US general population as the reference group. During the study period, 3554 deaths (2693 males and 861 females) in people with ASD were recorded in the United States. Annual numbers of decedents with ASD increased from 27 (accounting for 0.001% of total mortality) in 1999 to 514 (0.015% of total mortality) in 2021. Mean age at death for people with ASD was 39.9 years (SD 21.2 years; median 38.0 years) compared with 73.7 years (SD 19.2 years; median 78.0 years) for the general population. Of decedents with ASD, 693 (19.5%) were attributed to mental, behavioral, and neurodevelopmental disorders (PMR = 13.01; 95% CI = 12.06, 14.02), 435 (12.2%) to nervous system diseases (PMR = 3.58; 95% CI = 3.25, 3.93), 309 (8.7%) to respiratory system diseases (PMR = 1.82; 95% CI = 1.62, 2.03), 247 (6.9%) to endocrine, nutritional and metabolic diseases (PMR = 1.92 (1.69, 2.17), and 211 (5.9%) to digestive system diseases (PMR = 1.55; 95% CI =1.35, 1.78). These findings indicate a marked increase in the annual number of deaths among people with ASD and a 34-year gap in the mean age at death between those with ASD and the general population. Excess mortality in people with ASD is primarily due to mental, behavioral, and neurodevelopmental disorders and diseases of the nervous and respiratory systems.