Paul Lazarsfeld Center for Social Sciences, Columbia University, New York, USA.
J Epidemiol Community Health. 2011 Jun;65(6):503-10. doi: 10.1136/jech.2009.104588. Epub 2010 Oct 25.
The incidence of autism rose dramatically between 1992 and 2001, while the age at which children were first diagnosed declined. During this period the size and composition of the autism caseload has changed, but little is known about whether the factors associated with the timing of diagnosis may also have shifted. Using a multilevel analysis strategy, the individual and community-level factors associated with age of diagnosis were modelled across 10 birth cohorts of California children.
Linked birth and administrative records on 17,185 children with diagnoses of autistic disorder born in California between 1992 and 2001 and enrolled with the California Department of Developmental Services (DDS) were analysed. Information on cases, their parents and their residential location were extracted from birth and DDS records. Zip codes of residence were matched to census data to create community-level measures. Multilevel linear models were estimated for each birth cohort, with individual-level effects for sex, race, parental characteristics, poverty status, birth order and symptom expression. At the community level measures of educational and economic composition, local autism prevalence and the presence of a child psychiatrist were included.
Children with highly educated parents are diagnosed earlier, and this effect has strengthened over time. There is a persistent gap in the age of diagnosis between high and low socioeconomic status (SES) children that has shrunk but not disappeared over time.
Routine screening for autism in early childhood for all children, particularly those of low SES, is necessary to eliminate disparities in early intervention.
1992 年至 2001 年间，自闭症发病率急剧上升，而儿童首次确诊的年龄却有所下降。在此期间，自闭症患者的数量和构成发生了变化，但人们对与诊断时间相关的因素是否也发生了变化知之甚少。本研究采用多层次分析策略，对加利福尼亚州 10 个出生队列的儿童，对与诊断年龄相关的个体和社区层面的因素进行建模。
对 1992 年至 2001 年间在加利福尼亚州出生且被诊断为自闭症谱系障碍的 17185 名儿童的出生和行政记录进行了分析。病例、其父母及其居住地点的信息从出生和 DDS 记录中提取。居住邮编与人口普查数据相匹配，以创建社区层面的测量指标。对每个出生队列进行多层次线性模型估计，个体层面的效应因素包括性别、种族、父母特征、贫困状况、出生顺序和症状表现。在社区层面，纳入了教育和经济构成、当地自闭症患病率和儿童精神科医生的存在等测量指标。
父母受过高等教育的儿童更早被诊断出患有自闭症，而且这种效应随着时间的推移而增强。高社会经济地位（SES）和低 SES 儿童的诊断年龄差距一直存在，但随着时间的推移有所缩小。
有必要对所有儿童，尤其是社会经济地位较低的儿童进行自闭症早期筛查，以消除早期干预中的差异。
