SEARCHCROSS-SECTIONALepidemiology, public health

cross-sectional·epidemiology, public health, neurology, gastroenterology, rheumatology·PMC10510241

Increased rates of chronic physical health conditions across all organ systems in autistic adolescents and adults

Molecular Autism · 4 authors, 5 centres

AI SUMMARY

FIDELITY 92%

POPULATIONAutistic and non-autistic adolescents and adults (n=2305, mean age 41.6 years, 65.9% female, 49% autistic)

INTERVENTIONNone (observational study)

COMPARISONAutistic vs. non-autistic participants

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

“

TL;DR

This cross-sectional study of 2305 adults found that autistic individuals have significantly higher rates of chronic physical health conditions across nearly all organ systems compared to non-autistic individuals, even after adjusting for demographics, lifestyle factors, and family history. The findings highlight the need for healthcare professionals to be vigilant for a wide range of co-occurring physical conditions in autistic patients, including gastrointestinal, neurological, and rheumatological disorders. The study also provides novel evidence of increased multimorbidity in autistic people through network analysis.

Full summary

3,750 CHARS

**Background:** Autistic individuals have increased risks of co-occurring physical and mental health conditions, and significantly increased mortality and reduced life expectancy. Previous research has been limited by narrow focus on specific conditions, young age ranges, and lack of adjustment for lifestyle factors and family history. This study aimed to compare the long-term physical health of autistic and non-autistic adults across a broad range of organ systems, accounting for demographics, BMI, smoking, alcohol use, and family history, and to examine multimorbidity using network analysis.

**Methods:** A cross-sectional, convenience-sampling online survey (Autism and Physical Health Survey) was conducted between February 2018 and August 2019. Participants were aged 16+ years, recruited via databases, social media, and autism charities. After exclusions (self-diagnosed, suspected duplicates, incomplete responses), the final sample included 2305 participants (1129 autistic, 1176 non-autistic). The survey collected self-reported data on demographics, autism diagnosis, height/weight (BMI), smoking, alcohol use, and lifetime history of physical health conditions across organ systems (gastrointestinal, endocrine, rheumatological, neurological, ocular, otolaryngology, renal/hepatic, haematological, dermatological). Family medical history of first-degree relatives was also collected. Binomial logistic regression was applied across four iterative models: Model 1 (unadjusted), Model 2 (adjusted for sex, ethnicity, country, age, education), Model 3 (plus family history), Model 4 (plus BMI, smoking, alcohol). Benjamini-Hochberg correction was used for multiple testing. Conditions with <1% endorsement were excluded. Network analysis using the Ising Model compared multimorbidity patterns between groups.

**Key Results:** Autistic participants had significantly higher rates of conditions in all organ systems. For example, gastrointestinal conditions: autistic 38.56% vs. non-autistic 20.25% (Model 4 OR 2.69, 95% CI 2.14-3.39, p<0.0001); neurological: 29.70% vs. 17.87% (OR 2.14, 1.68-2.71, p<0.0001); rheumatological: 25.44% vs. 14.72% (OR 2.16, 1.66-2.80, p<0.0001); ocular: 44.24% vs. 35.83% (OR 1.61, 1.29-2.00, p<0.0001); dermatological: 29.97% vs. 21.78% (OR 1.65, 1.32-2.08, p<0.0001). Specific conditions with significantly elevated odds in fully adjusted models included irritable bowel syndrome (OR 2.44, 1.87-3.17), chronic constipation (OR 2.96, 1.94-4.51), fibromyalgia (OR 3.49, 2.04-5.95), migraine (OR 1.74, 1.35-2.24), tinnitus (OR 3.81, 2.19-6.63), and iron deficiency anaemia (OR 1.74, 1.22-2.47). Among females, Ehlers-Danlos Syndrome was strongly associated with autism (OR 7.34, 3.23-16.65). Coeliac disease was significant after adjusting for demographics and lifestyle (OR 2.55, 1.13-5.76) but not after family history. Network analysis showed greater global network strength in the autistic group (p=0.032), indicating increased multimorbidity.

**Clinical Implications:** This study provides robust evidence that autistic adults have a substantially higher burden of chronic physical health conditions across nearly all organ systems, independent of demographic and lifestyle factors. Healthcare professionals should maintain a high index of suspicion for a wide range of co-occurring conditions, particularly gastrointestinal, neurological, and rheumatological disorders, as well as central sensitivity syndromes. The findings support the need for comprehensive health checks and reasonable adjustments in healthcare settings for autistic individuals. Further research is needed to explore underlying mechanisms, including genetic factors (e.g., EDS, coeliac disease) and healthcare access barriers.

PICO

PPOPULATION

Autistic and non-autistic adolescents and adults (n=2305, mean age 41.6 years, 65.9% female, 49% autistic)

IINTERVENTION

None (observational study)

OOUTCOME

Self-reported lifetime prevalence of chronic physical health conditions across organ systems (gastrointestinal, neurological, endocrine, ocular, ear/nose/throat, skin, liver/kidney, haematological, rheumatological) and multimorbidity

STUDY TYPE

cross-sectional

SPECIALTY

epidemiology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

92% · A

ORIGINAL PAPER

PMC10510241

Increased rates of chronic physical health conditions across all organ systems in autistic adolescents and adults

Molecular Autism

READ THE FULL PAPER

ABSTRACT

Background The poorer physical health of autistic adults compared to non-autistic adults has been highlighted by several epidemiological studies. However, research has so far been limited to specific geographical areas and has primarily focused on young autistic individuals (aged 35 years and younger). Recent studies indicate a higher rate of mortality in autistic people, as well as poorer quality of self-reported healthcare interactions. This study aims to determine, first, whether autistic people experience greater levels of non-communicable health conditions and second, whether these are explained by differences in demographics (i.e. sex, country of residence, ethnicity, education level), alcohol use, smoking, body mass index (BMI), or family history of medical conditions. Method We employed a cross-sectional, convenience-sampling study via an anonymous, online survey of autistic and non-autistic adults (n = 2305, mean age = 41.6, 65.9% female, 49% autistic). The survey asked participants to self-report information about their demographics, autism diagnosis, diet, exercise, sleep, sexual health, substance use, personal medical history, and family medical history (for all first-degree, biological relatives). Binomial logistic regression across four iterative models of increasing complexity was applied to assess rates of physical health conditions. The Benjamini–Hochberg correction was used to account for multiple testing, and only physical health conditions that achieved at least 1% endorsement within the overall sample (n > 22) were included in the analysis to reduce risk of Type I errors. We also used novel network analysis methods to test whether there are increased levels of multimorbidity between autistic and non-autistic people. Results There were significantly elevated rates of non-communicable conditions across all organ systems in autistic people, including gastrointestinal, neurological, endocrine, visual, ear/nose/throat, skin, liver and kidney, and haematological conditions. We confirmed previous findings by showing highly significant differences in rates of neurological and gastrointestinal symptoms ( p < 0.0001). In addition, we established in the largest sample to date that Ehler-Danlos Syndrome (EDS) was more likely to occur among autistic females compared to non-autistic females. Finally, we found a higher prevalence of Coeliac’s disease among autistic individuals compared to non-autistic individuals after controlling for sex, ethnicity, country of residence, alcohol use, smoking, and BMI, but these results became non-significant after accounting for family history. Limitations Our study is biased towards females, white individuals, highly educated people, and UK residents, likely due to sampling biases. Our self-report study design may also exclude those who lack access to computers, or those with intellectual disability. Our network analysis is also limited in size. Conclusions This study provides evidence of widespread, physical health comorbidity that spans nearly all major organ systems in autistic adults compared to non-autistic adults, using both binary logistic regression and network models. Healthcare professionals must be made aware of the range of co-occurring physical health conditions that may be more common among autistic people. However, our findings also point towards potential avenues requiring further exploration, such as the association of autism with both Coeliac’s disease and EDS. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-023-00565-2.

CITATION EXPORT

John H. Ward, Elizabeth Weir, Carrie Allison et al.. Increased rates of chronic physical health conditions across all organ systems in autistic adolescents and adults. Molecular Autism. (2023). https://doi.org/10.1186/s13229-023-00565-2

AUTHORS

4 · 5 CENTRES

John H. Ward, Elizabeth Weir, Carrie Allison, Simon Baron-Cohen

1grid.451052.70000 0004 0581 2008Royal Devon University NHS Foundation Trust, Exeter, Devon, UK
2https://ror.org/03yghzc09grid.8391.30000 0004 1936 8024University of Exeter Medical School, Devon, UK
3https://ror.org/013meh722grid.5335.00000 0001 2188 5934Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 8AH, Cambridge, UK
4https://ror.org/052gg0110grid.4991.50000 0004 1936 8948University of Oxford, Department of Psychiatry, Oxford, UK
5https://ror.org/04c8bjx39grid.451190.80000 0004 0573 576XOxford Health NHS Foundation Trust, Oxford, UK