Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, and Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.
Pre-School Psychiatry Unit, Soroka University Medical Center, Beer-Sheva, Israel.
Epidemiol Psychiatr Sci. 2020 Jan 28;29:e95. doi: 10.1017/S2045796020000050.
Children with autism spectrum disorder (ASD) tend to suffer from various medical comorbidities. We studied the comorbidity burden and health services' utilisation of children with ASD to highlight potential aetiologies and to better understand the medical needs of these children.
In this nested case-control study, ASD cases and controls - matched by age, sex and ethnicity in a 1:5 ratio - were sampled from all children born between 2009 and 2016 at a tertiary medical centre. Data were obtained from the hospital's electronic database. Comorbid diagnoses were classified according to pathophysiological aetiology and anatomical/systemic classification of disease. Standard univariate and multivariate statistics were used to demonstrate comorbidities and health services' utilisation patterns that are significantly associated with ASD.
ASD children had higher rates of comorbidities according to both pathophysiological and anatomical/systemic classifications (p < 0.001). The most marked significant differences were observed for: hearing impairments (OR = 4.728; 95% CI 2.207-10.127) and other auricular conditions (OR = 5.040; 95% CI 1.759-14.438); neurological (OR = 8.198; 95% CI 5.690-11.813) and ophthalmological (OR = 3.381; 95% CI 1.617-7.068) conditions; and ADD/ADHD (OR = 3.246; 95% CI 1.811-5.818). A subgroup analysis revealed a more profound case-control difference in anaemia rates among girls than in boys (OR = 3.25; 95% CI 1.04-10.19 v. OR = 0.74; 95% CI 0.33-1.64 respectively) and an opposite trend (larger differences in males than in females in cardiovascular diseases (OR = 1.99; 95% CI 1.23-3.23 v. OR = 0.76; 95% CI 0.17-3.45, respectively)). In addition, larger case-control differences were seen among Bedouin children than in Jewish children in a number of medical comorbidities (Breslow-Day test for homogeneity of odds ratio p-value <0.05). Finally, we found that children with ASD tended to be referred to the emergency department and to be admitted to the hospital more frequently than children without ASD, even after adjusting for their comorbidity burden (aOR = 1.28; 95% CI 1.08-1.50 and aOR = 1.28; 95% CI 1.11-1.47 for >1 referrals and admissions per year, respectively).
The findings of this study contribute to the overall understanding of comorbid conditions and health services' utilisation for children with ASD. The higher prevalences of comorbidities and healthcare services' utilisation for children with ASD highlight the additional medical burden associated with this condition.
自闭症谱系障碍（ASD）儿童往往患有多种合并症。我们研究了 ASD 儿童的合并症负担和卫生服务利用情况，以突出潜在的病因，并更好地了解这些儿童的医疗需求。
在这项嵌套病例对照研究中，我们从一家三级医疗中心在 2009 年至 2016 年期间出生的所有儿童中，按照年龄、性别和种族以 1:5 的比例抽取 ASD 病例和对照。数据来自医院的电子数据库。根据病理生理学病因和解剖/系统疾病分类对合并症进行分类。使用标准单变量和多变量统计来证明与 ASD 显著相关的合并症和卫生服务利用模式。
根据病理生理学和解剖/系统分类，ASD 儿童的合并症发生率更高（p<0.001）。观察到最显著的显著差异是：听力障碍（OR=4.728；95%CI 2.207-10.127）和其他耳部疾病（OR=5.040；95%CI 1.759-14.438）；神经（OR=8.198；95%CI 5.690-11.813）和眼科（OR=3.381；95%CI 1.617-7.068）疾病；以及 ADD/ADHD（OR=3.246；95%CI 1.811-5.818）。亚组分析显示，女孩贫血发生率的病例对照差异比男孩更明显（OR=3.25；95%CI 1.04-10.19 v. OR=0.74；95%CI 0.33-1.64），而心血管疾病的趋势相反（男性的病例对照差异大于女性（OR=1.99；95%CI 1.23-3.23 v. OR=0.76；95%CI 0.17-3.45）。此外，在一些医疗合并症中，贝都因儿童与犹太儿童之间的病例对照差异更大（Breslow-Day 检验比值比同质性检验 p 值<0.05）。最后，我们发现，即使在考虑到合并症负担后，ASD 儿童也更倾向于前往急诊室就诊和住院治疗（每年>1 次就诊和住院的校正优势比[aOR]分别为 1.28；95%CI 1.08-1.50 和 1.28；95%CI 1.11-1.47）。
本研究的结果有助于全面了解 ASD 儿童的合并症和卫生服务利用情况。ASD 儿童合并症和卫生服务利用的更高患病率突出了与这种情况相关的额外医疗负担。
