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Physical Health of Autistic Adults
Currently, there are very few large-scale studies of physical health of autistic adults, despite evidence that autistic individuals have increased risk of premature mortality (Hirvikoski et al 2016; Pickett et al 2006). Previous research has found a higher health burden among autistic individuals in general, and specifically for neurological, psychiatric, gastrointestinal, muscular, metabolic, sleep, immune, and endocrine conditions (Croen et al 2015; Davignon et al 2018; Diallo et al 2017; Kohane et al 2012). In addition, it has been suggested that autistic females may be at even higher risk for medical comorbidities than autistic males (Croen et al 2015). Unfortunately, nearly all existing studies fail to sample autistic adults over the age of 35 years.
Objectives:
To identify common physical health comorbidities of autistic adults over the age of 35, and to determine if a sex bias exists regarding physical health conditions within this population.
Methods:
We developed an anonymous, online physical health survey via Qualtrics that inquired about demographics, lifestyle choices/ daily habits, personal medical history, and family medical history for first-degree biological relatives. As the survey attempted to be comprehensive regarding physical health conditions, it contained 512 questions on over 161 medical conditions and lifestyle choices, though it used a tiered structure to avoid survey fatigue. The survey was administered to individuals over the age of 16 years and individuals were asked to self-report any previous autism diagnosis. The AQ-10 was administered to individuals who did not report an autism diagnosis (henceforth ‘controls’) and individuals with an AQ score ≥6 were excluded. Participants included n=642 autistic individuals and n=361 controls, comprising a total of n=1,003 individuals. The mean age across both groups was approximately 43 years and there was a strong bias towards females, UK residents, and white individuals. Recruitment is ongoing, with efforts to recruit under-sampled demographics.
Results:
We conducted sex-stratified Fisher’s exact tests to determine the prevalence of four non-communicable diseases identified by the WHO as accounting for nearly 70% of worldwide mortality (cancer, cardiovascular conditions, respiratory conditions, diabetes). Autistic females were significantly more likely to have respiratory conditions (OR: 1.92; p-value: 0.0015; FDR: 0.0059), with additional trends toward significance for both diabetes (OR: 1.65; p-value: 0.086; FDR: 0.114) and cardiovascular conditions (OR: 1.47; p-value: 0.060; FDR: 0.114), as compared with control females.
Conclusions:
The results suggest that autistic females may be at greater risk of non-communicable diseases than others, particularly for respiratory conditions. These results confirm previous findings; however, it is essential to conduct additional studies in larger samples and with more representative populations. As we are still recruiting participants for this study, we hope to recruit a total sample size of 4,200 individuals, with a greater number of controls in particular.