Population Disparities in Autism Diagnosis in South Israel.

Poster Presentation
Saturday, May 4, 2019: 11:30 AM-1:30 PM
Room: 710 (Palais des congres de Montreal)
O. Kerub1, E. J. Haas2, G. Meiri3, H. Flusser4, A. Michaelovski3, I. Dinstein5, N. Davidovitch6, M. Gdalevich7 and I. Menashe8, (1)Ben-Gurion University, Ministry of Health, Be’er Sheva,, Israel, (2)Ministry of Health, Beer Sheva, Israel, (3)Soroka Medical Center, Beer Sheba, Israel, (4)Child Development / Pediatric, Ben Gurion University in the Negev, Be’er Sheva,, Israel, (5)Negev Autism Center, Ben Gurion University of the Negev, Beer Sheba, Israel, (6)Ben Gurion University in the Negev, Beer Sheva, Israel, (7)Ben-Gurion University in the Negev, Ministry of health, Be’er Sheva,, Israel, (8)Public Health Department, Ben-Gurion University, Beer Sheva, Israel

The rising incidence of autism spectrum disorder (ASD) has become a major public health concern. In Israel, ASD rates vary remarkably across geographic regions and ethnic populations, with one of the largest gaps observed between Jewish and Bedouin populations living in southern Israel.


To identify the reasons for the population disparities in ASD rates in southern Israel.

Methods: This study was conducted between March 2015 and January 2017 at 35 maternal child health centers (MCHCs) in southern Israel. A total of 3343 toddlers (996 Jewish and 2347 Bedouin at age 16-36 months were screened for ASD using the M-CHAT/F questionnaire. Toddlers who failed the M-CHAT/F were referred for further evaluation at the Soroka University Medical Center (SUMC). The diagnostic process at SUMC included several meetings with social workers, developmental psychologists, and expert physicians (a child psychiatrist or a child neurologist) who eventually provided a diagnosis according to DSM-5 criteria. Cox regression analysis was used to assess population differences in the diagnosis processes.


Overall, 39 Jewish (3.9%) and 70 Bedouin (3.0%) toddlers failed the M-CHAT/F (p=0.165 for population difference in failure rates). Jewish toddlers who failed the M-CHAT/F were significantly younger than Bedouin toddlers (20.15±3.38 vs. 23.77±5.01 respectively; p<0.001), and in both populations the male-to-female failure ratio was 2:1. Of the toddlers who failed the M-CHAT/F, 32 Jewish (82.1%) and 56 Bedouin (80.0%) started the diagnosis process at SUMC (p=0.795 for population difference). Notably, only 32 (57.1%) of the Bedouins that attended SUMC completed the diagnosis process compared to 27 (84%) of the Jewish toddlers (p<0.001). In addition, the time from referral until the first diagnosis meeting at SUMC was, on average, two months longer for Bedouins compared to Jewish toddlers (7.86 vs. 5.53; p=0.040). Consequently, the adjusted “risk” of Jewish toddlers who failed the M-CHAT/F to get a diagnosis of ASD was 2.8 higher compared to Bedouin toddlers (HR=2.8, 95%CI=1.01-7.75; p = 0.049), which explains the current ethnic differences in ASD prevalence in southern Israel (1.2% vs. 0.4% for Jewish and Bedouin toddlers respectively).


The observed population disparities in ASD prevalence between Jewish and Bedouin toddlers in southern Israel are likely stemming from delayed diagnosis and higher loss to follow-up rates among the Bedouin population. Raising awareness and Better case management for toddlers with suspected ASD from the Bedouin population would help in reducing the gap in ASD prevalence between Jewish and Bedouin toddlers in southern Israel.