Solmi Marco, Song Minjin, Yon Dong Keon, Lee Seung Won, Fombonne Eric, Kim Min Seo, Park Seoyeon, Lee Min Ho, Hwang Jimin, Keller Roberto, Koyanagi Ai, Jacob Louis, Dragioti Elena, Smith Lee, Correll Christoph U, Fusar-Poli Paolo, Croatto Giovanni, Carvalho Andre F, Oh Jae Won, Lee San, Gosling Corentin J, Cheon Keun-Ah, Mavridis Dimitris, Chu Che-Sheng, Liang Chih-Sung, Radua Joaquim, Boyer Laurent, Fond Guillaume, Shin Jae Il, Cortese Samuele
Department of Psychiatry, University of Ottawa, Ontario, ON, Canada.
Department of Mental Health, The Ottawa Hospital, Ontario, ON, Canada.
Mol Psychiatry. 2022 Oct;27(10):4172-4180. doi: 10.1038/s41380-022-01630-7. Epub 2022 Jun 29.
Autism spectrum disorder (ASD) substantially contributes to the burden of mental disorders. Improved awareness and changes in diagnostic criteria of ASD may have influenced the diagnostic rates of ASD. However, while data on trends in diagnostic rates in some individual countries have been published, updated estimates of diagnostic rate trends and ASD-related disability at the global level are lacking. Here, we used the Global Burden of Diseases, Injuries, and Risk Factors Study data to address this gap, focusing on changes in prevalence, incidence, and disability-adjusted life years (DALYs) of ASD across the world. From 1990 to 2019, overall age-standardized estimates remained stable globally. Both prevalence and DALYs increased in countries with high socio-demographic index (SDI). However, the age-standardized incidence decreased in some low SDI countries, indicating a need to improve awareness. The male/female ratio decreased between 1990 and 2019, possibly accounted for by increasing clinical attention to ASD in females. Our results suggest that ASD detection in low SDI countries is suboptimal, and that ASD prevention/treatment in countries with high SDI should be improved, considering the increasing prevalence of the disorder. Additionally, growing attention is being paid to ASD diagnosis in females, who might have been left behind by ASD epidemiologic and clinical research previously. ASD burden estimates are underestimated as GBD does not account for mortality in ASD.
自闭症谱系障碍（ASD）在精神障碍负担中占相当大的比重。对ASD认识的提高以及诊断标准的变化可能影响了ASD的诊断率。然而，尽管一些个别国家的诊断率趋势数据已经公布，但全球层面缺乏对诊断率趋势和与ASD相关残疾的最新估计。在此，我们利用全球疾病、伤害及风险因素负担研究数据来填补这一空白，重点关注全球范围内ASD的患病率、发病率和伤残调整生命年（DALYs）的变化。从1990年到2019年，全球总体年龄标准化估计值保持稳定。社会人口指数（SDI）较高的国家中，患病率和DALYs均有所上升。然而，一些低SDI国家的年龄标准化发病率下降，这表明需要提高认识。1990年至2019年间，男女比例下降，这可能是由于对女性ASD的临床关注度增加所致。我们的结果表明，低SDI国家对ASD的检测并不理想，考虑到该疾病患病率的上升，高SDI国家的ASD预防/治疗应加以改善。此外，女性ASD诊断正受到越来越多的关注，她们此前可能被ASD流行病学和临床研究所忽视。由于全球疾病负担研究未考虑ASD中的死亡率，ASD负担估计被低估。
