Wu Chi-Shin, Tsai Hui-Ju, Chien Yi-Ling, Gau Susan Shur-Fen
National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan Town, Taiwan.
Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Douliu City, Taiwan.
Autism Adulthood. 2025 Feb 5;7(1):81-92. doi: 10.1089/aut.2023.0103. eCollection 2025 Feb.
Western studies have reported a higher mortality risk in autistic individuals. However, the specific causes of death and the roles of age, sex, and concurrent intellectual disability (ID) remain unclear. This study aimed to analyze the causes of death in autism and the moderating effects of age, sex, and concurrent ID.
This nationwide population-based study, conducted between 2008 and 2019, identified 64,685 autistic individuals and were age and sex matched with 1,279,174 nonautistic controls. All-cause mortality and specific causes of death were compared between autistic and nonautistic controls. The modifying effects of age, sex, and concurrent ID were also examined.
The risk of all-cause mortality (hazard ratio = 2.28) is higher in autistic individuals than in nonautistic controls. The elevated all-cause mortality in autistic individuals was consistent across sex, age, and the presence or absence of ID and was higher in autistic women, adults, and those with concurrent ID than in their counterparts. The mortality risks for most examined specific causes, except cancer, are higher in the autistic group than those in nonautistic controls. Although autistic individuals with concurrent ID showed higher mortality risks in neurological, respiratory, and gastrointestinal categories and accidents, the risk of suicide is lower. Autistic women had higher mortality risks in most categories, whereas autistic adults had a higher mortality risk in the neurological and respiratory categories.
Autistic individuals face higher mortality risks across various disease categories, regardless of sex, age, or concurrent ID. Health care policies should prioritize the implementation of specific strategies for the early detection of diseases and health promotion, as well as accident and suicide prevention among autistic women and those without ID. Clinical Trial Registration number: NCT04010422.
西方研究报告称自闭症患者的死亡风险更高。然而，具体死因以及年龄、性别和并发智力残疾（ID）的作用仍不明确。本研究旨在分析自闭症患者的死因以及年龄、性别和并发ID的调节作用。
这项基于全国人口的研究在2008年至2019年期间进行，确定了64,685名自闭症患者，并与1,279,174名非自闭症对照者进行年龄和性别匹配。比较了自闭症患者和非自闭症对照者的全因死亡率和具体死因。还研究了年龄、性别和并发ID的修正作用。
自闭症患者的全因死亡风险（风险比=2.28）高于非自闭症对照者。自闭症患者全因死亡率升高在性别、年龄以及是否存在ID方面是一致的，并且自闭症女性、成年人以及并发ID者的死亡率高于其对应人群。除癌症外，自闭症组中大多数所研究的具体死因的死亡风险高于非自闭症对照者。虽然并发ID的自闭症患者在神经、呼吸和胃肠道疾病类别以及事故方面显示出更高的死亡风险，但自杀风险较低。自闭症女性在大多数类别中具有更高的死亡风险，而自闭症成年人在神经和呼吸疾病类别中具有更高的死亡风险。
无论性别、年龄或并发ID如何，自闭症患者在各类疾病中都面临更高的死亡风险。医疗保健政策应优先实施针对疾病早期检测、健康促进以及自闭症女性和无ID者的事故和自杀预防的具体策略。临床试验注册号：NCT04010422。
