Jain Anjali, Spencer Donna, Yang Wenya, Kelly Jonathan P, Newschaffer Craig J, Johnson Jonathan, Marshall Jaclyn, Azocar Francisca, Tabb Loni Philip, Dennen Taylor
Lewin Group, Falls Church, Va.
OptumInsight Life Sciences, Eden Prairie, Minn.
Acad Pediatr. 2014 Jul-Aug;14(4):390-7. doi: 10.1016/j.acap.2014.03.012.
We compared risk of injury among children with autism spectrum disorder (ASD) to those without ASD, adjusting for demographic and clinical characteristics.
We used claims data from 2001 to 2009 from a commercial health plan in the United States. A validated ASD case identification algorithm identified 33,565 children (ages 0-20 years) with ASD and 138,876 children without. Counting process models tested the association between ASD status and injury episodes with separate regressions run for children during different age periods.
Unadjusted results demonstrated that children with ASD had a 12% greater injury risk than children without ASD (hazard ratio [HR] = 1.119; P < .001). After including demographic variables, the HR was 1.03 (P < .05); after controlling for co-occurring conditions, such as seizures, depression, etc, HR decreased to 0.889 (P < .001). For the age period analysis, HR values were as follows: for 0 to 2 years, HR 1.141; 3 to 5 years, HR 1.282; 6 to 10 years, HR not significant; and 11 to 20 years, HR 0.634 (P < .05 for all significant results).
Children with ASD have more injuries than children without ASD. After controlling for demographic factors and co-occurring conditions, children with ASD are at lower risk of injury, suggesting that co-occurring conditions or the ways these conditions interact with ASD is related to injuries. Clinicians should understand that injury risk in children with ASD may be driven by co-occurring conditions. Treating these conditions could thus decrease injury risk as well as have other benefits. Injury prevention interventions are especially warranted for younger children with ASD and those with seizures, depression, visual impairment, or attention-deficit disorders.
我们比较了自闭症谱系障碍（ASD）儿童与非ASD儿童的受伤风险，并对人口统计学和临床特征进行了调整。
我们使用了来自美国一家商业健康保险计划的2001年至2009年的理赔数据。一种经过验证的ASD病例识别算法识别出33565名患有ASD的儿童（年龄0至20岁）和138876名未患ASD的儿童。计数过程模型通过对不同年龄段儿童进行单独回归分析，检验了ASD状态与受伤事件之间的关联。
未经调整的结果显示，患有ASD的儿童比未患ASD的儿童受伤风险高12%（风险比[HR]=1.119；P<.001）。纳入人口统计学变量后，HR为1.03（P<.05）；在控制癫痫、抑郁等共病情况后，HR降至0.889（P<.001）。对于年龄阶段分析，HR值如下：0至2岁，HR为1.141；3至5岁，HR为1.282；6至10岁，HR无显著差异；11至20岁，HR为0.634（所有显著结果P<.05）。
患有ASD的儿童比未患ASD的儿童受伤更多。在控制人口统计学因素和共病情况后，患有ASD的儿童受伤风险较低，这表明共病情况或这些情况与ASD的相互作用方式与受伤有关。临床医生应明白，患有ASD的儿童的受伤风险可能由共病情况驱动。因此，治疗这些情况可能会降低受伤风险以及带来其他益处。对于患有ASD的年幼儿童以及患有癫痫、抑郁、视力障碍或注意力缺陷障碍的儿童，尤其需要采取预防受伤的干预措施。
