SEARCHCROSS-SECTIONALepidemiology, public health

cross-sectional·epidemiology, public health, neurology, gastroenterology, internal medicine·PMC10510241

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

Molecular Autism · 4 authors, 5 centres

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Using binomial logistic regression across four models adjusting for demographics, family history, and lifestyle factors, the authors found significantly elevated odds of conditions in all organ systems for autistic people. Limitations include sampling biases toward females, white individuals, highly educated people, and UK residents, as well as potential exclusion of those without computer access or with intellectual disability. The findings support widespread physical health comorbidity in autistic adults.

STUDY TYPE

cross-sectional

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epidemiology

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ORIGINAL PAPER

PMC10510241

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

Molecular Autism

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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