Objectives: To elucidate differences in health and social outcomes for adults with autism spectrum disorders based on urbanicity. Participants were described as urban or rural residents according to U.S. Census definitions.
Methods: This study used 30-year follow-up data from a population-based sample of 305 individuals. Urban and rural classifications were based on county of residence and the determination of county demographics by the U.S. 2010 Census. Outcome variables included demographic factors, education and employment history, activities of daily living, access to healthcare services, and medical and psychiatric comorbidity. Procedures included direct assessment of the participants and semi-structured interviews and checklists completed with caregivers or family members. An outcome coding schema of employment, relationships, independence and an overall composite of functioning was created based upon a thorough review of each case.
Results: Of the original sample, 58 cases were excluded due to mortality or invalid current addresses (29 and 29, respectively), reducing the sample to 247 individuals. Of this, the majority were male (77%) living in an urban county (86%). The average age of this sample was 37 (SD 5.9, range 28-55). Group differences for education and employment suggested higher levels of education in the urban sample but a high proportion of participants currently employed in the rural sample, although neither comparison was significant. There was a trend for those living in urban areas to have more relationships and social interaction (z=1.55, p=0.06). No substantial differences were found for independence or overall composite of functioning. Use of services was higher in the urban sample for hospitalizations, case management, psychiatric services, nursing, and therapy; however, none of these reached significance. Conversely, respite care was significantly higher in the rural sample (z=2.32, p<.01). Caution should be used in interpreting this finding due to small sample size and high standard deviation. There were no differences based on urbanicity between psychiatric comorbidities, medical diagnoses, or use medication use.
Conclusions: Although there were several differences in participant outcomes based on urban and rural status, few reached statistical significance in this sample. The trend for those in urban settings to have more social interaction is reasonable given greater population density. From a practical standpoint, the trend for those in rural areas to have higher rates of current employment may suggest that there is greater job retention in rural areas for individuals with autism spectrum disorders.