O'Sharkey Karl, Mitra Sanjali, Paik Seung-A, Chow Ting, Cockburn Myles, Ritz Beate
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, 90095, USA.
Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, 90032, USA.
J Autism Dev Disord. 2024 May 3. doi: 10.1007/s10803-024-06371-w.
Autism Spectrum Disorders (ASD) prevalence has risen globally, with regional variation and sociodemographic disparities affecting diagnosis and intervention. This study examines ASD trends from 1990 to 2018 in California (CA), focusing on sociodemographic factors that may inform policy/interventions. Using CA Department of Public Health birth records (1990-2018) and Developmental Services ASD cases (1994-2022), we analyzed diagnosis incidence by age 4 or 8, stratified by sociodemographic and regional factors. From 1990 to 2018, for each birth year the cumulative incidence of ASD by 4 and 8 years of age in CA increased while the diagnosis age decreased. Distinct patterns emerged over these three decades. Children born to White and Asian and Pacific Islander (API) mothers, or to mothers with higher education or living in high socioeconomic status (SES) neighborhoods exhibited higher ASD cumulative incidences throughout the 1990s and early 2000s. However, in the mid-2000s, ASD incidence in children born to Black or Hispanic mothers, with low education, or living in low SES neighborhoods surpassed that of White/API children or those living in high SES neighborhoods. Black or Hispanic children now have the highest ASD cumulative incidence, even though age at first diagnosis remains lowest in high SES regions, for the highly educated, and for White/API children. ASD cumulative incidence in CA from 1990 to 2018 exhibited demographic reversals with higher rates in children born to Black or Hispanic mothers or lower SES neighborhoods. Black and Hispanic children still have delayed age at diagnosis compared to White/API children.
自闭症谱系障碍（ASD）的患病率在全球范围内呈上升趋势，存在地区差异以及社会人口统计学差异影响着诊断和干预。本研究考察了1990年至2018年加利福尼亚州（CA）的ASD趋势，重点关注可能为政策/干预措施提供信息的社会人口统计学因素。利用加利福尼亚州公共卫生部的出生记录（1990 - 2018年）和发育服务ASD病例（1994 - 2022年），我们按社会人口统计学和地区因素分层，分析了4岁或8岁时的诊断发病率。从1990年到2018年，对于每个出生年份，加利福尼亚州4岁和8岁时ASD的累积发病率上升，而诊断年龄下降。在这三十年中出现了不同的模式。在整个20世纪90年代和21世纪初，白人、亚裔及太平洋岛民（API）母亲所生的孩子，或母亲受教育程度较高或生活在高社会经济地位（SES）社区的孩子，ASD累积发病率较高。然而，在21世纪中期，黑人或西班牙裔母亲所生、受教育程度低或生活在低SES社区的孩子的ASD发病率超过了白人/API孩子或生活在高SES社区的孩子。黑人或西班牙裔儿童现在的ASD累积发病率最高，尽管在高SES地区、高学历人群以及白人/API儿童中，首次诊断年龄仍然最低。1990年至2018年加利福尼亚州的ASD累积发病率呈现出人口统计学上的逆转，黑人或西班牙裔母亲所生的孩子或低SES社区的孩子发病率更高。与白人/API儿童相比，黑人和西班牙裔儿童的诊断年龄仍然较晚。
