Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Departamento de Direitos Humanos, Saúde e Diversidade Cultural. Rio de Janeiro, RJ, Brasil.
Instituto Nacional de Câncer José Alencar Gomes da Silva. Rio de Janeiro, RJ, Brasil.
Rev Saude Publica. 2023 Apr 14;57:21. doi: 10.11606/s1518-8787.2023057004710. eCollection 2023.
To investigate the factors associated with the early diagnosis of autism and other types of pervasive developmental disorder (PDD) in children treated at the Psychosocial Care Center for Children and Adolescents of the Unified Health System, from 2013 to 2019,in Brazil.
An exploratory cross-sectional study, based on data from the Record of Outpatient Health Actions (RAAS) of the first appointment of children aged 1 to 12 years. The gross (RRg) and adjusted (RRa) relative risks and respective 95% confidence intervals (95%CI) were estimated using the Poisson regression model with robust variance estimation.
Of the 22,483 children included in the study, the majority were male (81.9%), lived in the same municipality where they were diagnosed (96.8%) and in the Southeast region (57.7%). Early diagnosis was higher for childhood autism (RRg = 1.48; 95%CI 1.27-1.71) , PDD without subtype designation (RRg = 1.55; 95%CI 1.34-1.80), other PDD (RRg = 1.48; 95%CI 1.21-1.81) and PDD not otherwise specified (RRg = 1.44; 95%CI 1.22-1.69) than for atypical autism. Children residing in the same municipality where the diagnosis was made had a higher rate of early diagnosis (RRg = 1.31; 95%CI 1.10-1.55) than the others; as well as those referred by primary care (RRg = 1.51; 95%CI 1.37-1.68) and by spontaneous demand (RRg = 1.45; 95%CI 1.31-1.61) than those from other types of referral. Early diagnosis was higher from 2014 and lower in the North region than in the other regions. In the multiple analysis, the magnitude of RRa was similar to that of RRg.
Early identification of autism and other PDD has improved in Brazil, but it still represents about 30% of the diagnoses made. The variables included in the model were significant, but still explain little of the early diagnosis of children with autism and other PDD.
调查 2013 至 2019 年期间，巴西统一卫生系统儿童心理社会保健中心治疗的儿童自闭症和其他类型广泛性发育障碍（PDD）的早期诊断相关因素。
本研究为探索性病例对照研究，基于首次就诊于 1 至 12 岁儿童的门诊医疗记录（RAAS）数据。使用泊松回归模型，采用稳健方差估计，对粗（RRg）和调整（RRa）相对风险及其各自 95%置信区间（95%CI）进行估计。
本研究共纳入 22483 名儿童，其中大多数为男性（81.9%），在诊断所在同一市（96.8%）和东南部（57.7%）居住。儿童自闭症（RRg=1.48；95%CI 1.27-1.71）、未指定亚型的 PDD（RRg=1.55；95%CI 1.34-1.80）、其他 PDD（RRg=1.48；95%CI 1.21-1.81）和未特指 PDD（RRg=1.44；95%CI 1.22-1.69）的早期诊断率高于非典型自闭症。在诊断所在同一市居住的儿童早期诊断率较高（RRg=1.31；95%CI 1.10-1.55），高于其他地区；初级保健转诊（RRg=1.51；95%CI 1.37-1.68）和自发转诊（RRg=1.45；95%CI 1.31-1.61）的儿童早期诊断率高于其他类型转诊的儿童。2014 年以后，早期诊断率有所提高，而北部地区的早期诊断率低于其他地区。在多变量分析中，RRa 的大小与 RRg 相似。
巴西的自闭症和其他 PDD 的早期识别有所改善，但仍占诊断病例的 30%左右。模型中纳入的变量具有统计学意义，但仍不能很好地解释自闭症和其他 PDD 儿童的早期诊断情况。
