The health status of adults on the autism spectrum

TLDR: Nearly all medical conditions were significantly more common in adults with autism, including immune conditions, gastrointestinal and sleep disorders, seizure, obesity, dyslipidemia, hypertension, and diabetes.

Abstract: Compared to the general pediatric population, children with autism have higher rates of co-occurring medical and psychiatric illnesses, yet very little is known about the general health status of adults with autism. The objective of this study was to describe the frequency of psychiatric and medical conditions among a large, diverse, insured population of adults with autism in the United States. Participants were adult members of Kaiser Permanente Northern California enrolled from 2008 to 2012. Autism spectrum disorder cases (N = 1507) were adults with autism spectrum disorder diagnoses (International Classification of Diseases-9-Clinical Modification codes 299.0, 299.8, 299.9) recorded in medical records on at least two separate occasions. Controls (N = 15,070) were adults without any autism spectrum disorder diagnoses sampled at a 10:1 ratio and frequency matched to cases on sex and age. Adults with autism had significantly increased rates of all major psychiatric disorders including depression, anxiety...

Figures

Table 4. Prevalence of medical conditions among adults with ASD and controls

Table 3. Variation in prevalence of psychiatric conditions among adults with ASD by gender.

Table 5 (continued). Variation in prevalence of medical conditions among adults with ASD by gender.

Table 1: Characteristic of Study Population: Adults 18 Years and Older From the Kaiser Permanente Medical Care Program in Northern California

Table 5 (continued). Variation in prevalence of medical conditions among adults with ASD by gender.

Table 2. Prevalence of psychiatric conditions in adults with ASD and controls

Full text

UCSF
UC San Francisco Previously Published Works
Title
The health status of adults on the autism spectrum.
Permalink
https://escholarship.org/uc/item/3v42r5rs
Authors
Croen, Lisa A
Zerbo, Ousseny
Qian, Yinge
et al.
Publication Date
2015-04-24
Peer reviewed
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University of California

Title: The Health Status of Adults on the Autism Spectrum
Authors:
Lisa A. Croen, PhD
1
Ousseny Zerbo, PhD
1
Yinge Qian, PhD
1
Maria L. Massolo, PhD
1
Steve Rich, MD
2
Stephen Sidney, MD, MPH
1
Clarissa Kripke, MD
3
Notice: This is the author’s version of a work that was accepted for publication.
Changes resulting from the publishing process, such as peer review, editing,
corrections, structural formatting, and other quality control mechanisms may not be
reflected in this document. Changes may have been made to this work since it was
submitted for publication.
A definitive version was subsequently published:
http://aut.sagepub.com/content/early/2015/04/23/1362361315577517.full

The Health Status of Adults on the Autism Spectrum
Lisa A. Croen, PhD
1
Ousseny Zerbo, PhD
1
Yinge Qian, PhD
1
Maria L. Massolo, PhD
1
Steve Rich, MD
2
Stephen Sidney, MD, MPH
1
Clarissa Kripke, MD
3
1
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
2
Santa Rosa Medical Center, Kaiser Permanente Northern California, Santa Rosa, CA,
USA
3
Family and Community Medicine, University of California, San Francisco, CA, USA
Word Count: 2853
Corresponding Author: Lisa A Croen, PhD, Kaiser Permanente Division of Research,
2000 Broadway, Oakland, CA 94612; Telephone: 510-891-3463; FAX: 510-891-
3802;email: Lisa.A.Croen@kp.org.

Acknowledgements
Lisa Croen had full access to all of the data in the study and takes responsibility for the
integrity of the data and the accuracy of the data analysis. Ousseny Zerbo and Yinge
Qian from the Division of Research, Kaiser Permanente Northern California, conducted
and are responsible for the data analyses. All authors have no conflicts of interest. We
thank the members of the KPNC ASD in Adults Workgroup for their valuable insights
and generous input regarding study design, data analysis, and interpretation of study
results. No compensation was received for these contributions. The members include
Stephen Rich, MD, Scott Rich, MA, Opal Thornton, MD, Clarissa Kripke, MD, Agnes
Amistoso, MA, Elizabeth Dixon, LCSW, Chuck Trumble, MFT, Stephen Sidney, MD,
Ousseny Zerbo, PhD, Maria Massolo, PhD, Carmen Ancinas-Gee, MFT and Neeraja
Maramreddy, MD. Preliminary findings were presented at the International Meeting for
Autism Research in Atlanta, Georgia in May, 2014.
Funder
This study was funded by a grant from the Special Hope Foundation, who had no role in
the design and conduct of the study; collection, management, analysis, and
interpretation of the data; or preparation, review, or approval of the manuscript.

Abstract
Compared to the general pediatric population, children with autism have higher rates of
co-occurring medical and psychiatric illnesses, yet very little is known about the general
health status of adults with autism. The objective of this study was to describe the
frequency of psychiatric and medical conditions among a large, diverse, insured
population of adults with autism in the US. Participants were adult members of Kaiser
Permanente Northern California enrolled from 2008-2012. ASD cases (N=1,507) were
adults with ASD diagnoses (ICD-9-CM 299.0, 299.8, 299.9) recorded in medical records
on at least 2 separate occasions. Controls (N=15,070) were adults without any ASD
diagnoses sampled at a 10:1 ratio and frequency matched to cases on sex and age.
Adults with autism had significantly increased rates of all major psychiatric disorders
including depression, anxiety, bipolar disorder, obsessive compulsive disorder,
schizophrenia, and suicide attempts. Nearly all medical conditions were significantly
more common in adults with autism, including immune conditions, GI and sleep
disorders, seizure, obesity, dyslipidemia, hypertension, and diabetes. Rarer conditions,
such as stroke and Parkinson’s disease, were also significantly more common among
adults with autism. Future research is needed to understand the social, health care
access and biological factors underlying these observations.

Frequently asked questions

Q1. What are the contributions in this paper?

The objective of this study was to describe the frequency of psychiatric and medical conditions among a large, diverse, insured population of adults with autism in the US. 

Q2. What are the future works in this paper?

Further epidemiologic research in large populations is needed to elucidate the association between autism and chronic conditions including cancer and identify explanatory factors for their observed associations. Tactile sensitivities may interfere with routine medical exams, further leading to delayed diagnosis and treatment of medical conditions ( Bauman 2010 ). 

Q3. What are the main factors that can cause barriers to participation in organized sports and physical activity?

Lack ofaccommodation for social and language impairments can create barriers to participatingin organized sports and physical activity (Pan and Frey 2006). 

Q4. How many adults with ASD had a diagnosis of intellectual disability?

Approximately one fifth(19.2%) of adults with ASD also had a diagnosis of intellectual disability (12.8% mild,3.1% moderate, 6.2% severe, 77.9% level not specified). 

Q5. What are the main factors that may cause the risk of many conditions?

the core impairments in autism and lack of health education, supports andaccommodations may result in lifestyle factors that are known risk factors for manypsychiatric and medical conditions. 

Q6. What were the common conditions among adults with ASD?

Rarer conditions, such as stroke, Parkinson’s disease, vitamin deficiency, vision andhearing impairments, and genetic disorders were also significantly more commonamong adults with ASD than controls (Table 4). 

Q7. What was the rate of suicide among adults with ASD?

While the rate of suicideattempt was higher among adults with ASD with a diagnosis of depression (3.6%)compared to adults with ASD without a diagnosis of depression (1.2%), only 14/27adults with ASD who attempted suicide had a diagnosis of depression. 

Q8. What were the common conditions among men with ASD?

both men and women hadincreased risks of most conditions compared to unaffected controls, except forautoimmune diseases and gastrointestinal disorders, which were significantly elevatedonly among men with ASD, and stroke which was significantly elevated only amongwomen with ASD (Table 5). 

Q9. What were the common chronic medical conditions among adults with ASD?

In addition, adultswith ASD had significantly higher prevalence of common chronic medical conditions,including dyslipidemia (22.8% vs. 15.1%), hypertension (25.6% vs. 15.6%), diabetes(7.6% vs. 4.3%), obesity (33.9% vs. 27.0%), and thyroid disease (7.0% vs. 3.1%). 

Q10. How many adults were sampled for ASD?

A comparison population (N=15,070) was randomly sampled at a 10:1 ratio fromamong all adult members who did not have any ASD diagnoses recorded in KPNCmedical records by December 2012. 

Q11. Why was the suicide rate lower in their study?

The rate in their study (1.8%) wassubstantially lower, likely because it reflected suicide attempts only (not ideation) in a 5-year period, and not lifetime experiences.