Time trends in autism diagnosis over 20 years: a UK population-based cohort study
Time trends in autism diagnosis over 20 years: a UK population-based cohort study
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DOI：
10.1111/jcpp.13505
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发表时间：
2021-08-19
影响因子：
7.6
通讯作者：
Ford, Tamsin
中科院分区：
文献类型：
--
作者：
Russell, Ginny;Stapley, Sal;Ford, Tamsin
背景自闭症谱系障碍是一种越来越多应用的诊断;然而，以前的研究有相互矛盾的发现，无论是在英国的诊断率继续增长。这项研究测试了接受新自闭症诊断的人的比例是否在20年的时间里一直在增加，无论是总体还是亚组。方法：基于人群的研究，使用临床实践研究数据链（CPRD）初级保健数据库，其中包含1998年至2018年期间向CPRD提供数据的实践注册的患者（1998年N = 6，786，212至2018年N = 9，594，598）。2018年有65，665名患者被诊断患有自闭症。绘制了所有自闭症诊断的新（事件）病例的时间趋势，并按性别、诊断亚型和发育阶段分层：婴儿期和学龄前，0-5岁;儿童期，6-11岁;青春期，12-19岁;成人，19岁以上。结果1998年至2018年期间，记录的自闭症诊断发生率呈指数增长787%; R-2 = 0.98，指数系数= 1.07，95% CI [1.06，1.08]，p < .001。女性的诊断率增幅大于男性（指数交互系数= 1.02，95% CI [1.01，1.03]，p < .001），并受年龄段的调节，成人的诊断率增幅最大（指数交互系数= 1.06，95% CI [1.04，1.07]，p < .001）。结论增加可能是由于患病率的增加，或者更可能是由于诊断报告和应用的增加。成年人、女性和功能更高的个体中越来越多的诊断表明，增强的识别是这些变化的基础。
Background Autism spectrum disorder is a diagnosis that is increasingly applied; however, previous studies have conflicting findings whether rates of diagnosis rates continue to grow in the UK. This study tested whether the proportion of people receiving a new autism diagnosis has been increasing over a twenty-year period, both overall and by subgroups. Method Population-based study utilizing the Clinical Practice Research Datalink (CPRD) primary care database, which contains patients registered with practices contributing data to the CPRD between 1998 and 2018 (N = 6,786,212 in 1998 to N = 9,594,598 in 2018). 65,665 patients had a diagnosis of autism recorded in 2018. Time trend of new (incident) cases of autism diagnosis was plotted for all, and stratified by gender, diagnostic subtypes, and developmental stage: infancy and preschool, 0-5 years old; childhood, 6-11 years old; adolescence, 12-19 years old; adults, over 19 years old. Results There was a 787%, exponential increase in recorded incidence of autism diagnoses between 1998 and 2018; R-2 = 0.98, exponentiated coefficient = 1.07, 95% CI [1.06, 1.08], p < .001. The increase in diagnoses was greater for females than males (exponentiated interaction coefficient = 1.02, 95% CI [1.01, 1.03], p < .001) and moderated by age band, with the greatest rises in diagnostic incidence among adults (exponentiated interaction coefficient = 1.06, 95% CI [1.04, 1.07], p < .001). Conclusions Increases could be due to growth in prevalence or, more likely, increased reporting and application of diagnosis. Rising diagnosis among adults, females and higher functioning individuals suggest augmented recognition underpins these changes.