The Children's Hospital of Philadelphia, USA.
University of Pennsylvania, USA.
Autism. 2023 Aug;27(6):1840-1846. doi: 10.1177/13623613221147396. Epub 2023 Jan 18.
Historically, children from non-Hispanic Black and Hispanic backgrounds, those from lower-income families, and girls are less likely to be diagnosed with autism spectrum disorder. Under-identification among these historically and contemporaneously marginalized groups can limit their access to early, autism spectrum disorder-specific interventions, which can have long-term negative impacts. Recent data suggest that some of these trends may be narrowing, or even reversing. Using electronic health record data, we calculated autism spectrum disorder prevalence rates and age of first documented diagnosis across socio-demographic groups. Our cohort included children seen at young ages (when eligible for screening in early childhood) and again at least after 4 years of age in a large primary care network. We found that autism spectrum disorder prevalence was unexpectedly higher among Asian children, non-Hispanic Black children, children with higher Social Vulnerability Index scores (a measure of socio-economic risk at the neighborhood level), and children who received care in urban primary care sites. We did not find differences in the age at which autism spectrum disorder diagnoses were documented in children's records across these groups. Receiving primary care at an urban site (regardless of location of specialty care) appeared to account for most other socio-demographic differences in autism spectrum disorder prevalence rates, except among Asian children, who remained more likely to be diagnosed with autism spectrum disorder after controlling for other factors. We must continue to better understand the process by which children with autism spectrum disorder from traditionally under-identified and under-served backgrounds come to be recognized, to continue to improve the equity of care.
从历史上看，非西班牙裔黑人和西班牙裔背景的儿童、来自低收入家庭的儿童和女孩被诊断出患有自闭症谱系障碍的可能性较小。在这些历史上和当前处于边缘地位的群体中，识别不足可能会限制他们获得早期自闭症谱系障碍特异性干预的机会，这可能会产生长期的负面影响。最近的数据表明，其中一些趋势可能正在缩小，甚至正在逆转。我们使用电子健康记录数据，计算了社会人口统计学群体中的自闭症谱系障碍患病率和首次记录诊断的年龄。我们的队列包括在幼儿时期（有资格在幼儿期进行筛查时）和至少在 4 岁后在大型初级保健网络中再次接受检查的儿童。我们发现，亚洲儿童、非西班牙裔黑人儿童、社会脆弱性指数评分较高的儿童（衡量邻里层面的社会经济风险的指标）和在城市初级保健点接受护理的儿童中，自闭症谱系障碍的患病率出人意料地更高。我们没有发现自闭症谱系障碍诊断在这些群体中记录在儿童记录中的年龄存在差异。在城市初级保健点（无论专科保健的位置如何）接受初级保健似乎可以解释自闭症谱系障碍患病率在其他社会人口统计学差异中占大多数，除了亚洲儿童，在控制了其他因素后，他们被诊断为自闭症谱系障碍的可能性仍然更高。我们必须继续更好地了解自闭症谱系障碍儿童从传统上被低估和服务不足的背景中被识别出来的过程，以继续提高护理的公平性。
