In-hospital mortality among adults with autism spectrum disorder in the United States: A retrospective analysis of US hospital discharge data
In-hospital mortality among adults with autism spectrum disorder in the United States: A retrospective analysis of US hospital discharge data
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DOI：
10.1177/1362361319855795
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发表时间：
2020-01-01
期刊：
影响因子：
5.2
通讯作者：
Lauer, Emily
中科院分区：
文献类型：
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作者：
Akobirshoev, Ilhom;Mitra, Monika;Lauer, Emily
使用 2004-2014 年医疗保健成本和利用项目全国住院患者样本进行回顾性数据分析，以检查美国自闭症谱系障碍成人与普通人群的住院死亡率。我们建立了逻辑回归模型，以 1:3 的比例比较自闭症谱系障碍成人 (n = 34,237) 与年龄匹配和性别匹配的对照 (n = 102,711) 之间的住院死亡率。患有自闭症谱系障碍的成年人住院死亡率高于对照组（比值比 = 1.44，95% 置信区间：1.29-1.61，p < 0.001）。即使在调整了年龄、性别、种族/民族、收入、合并症数量、癫痫和精神合并症、医院床位大小、医院地区和住院年份后，这种风险仍然很高（优势比 = 1.51，95% 置信区间：1.33-1.72，p < 0.001）。患有院内死亡的自闭症谱系障碍成人在死亡时有 27 种观察到的基于 Elixhauser 的医疗合并症中的 10 种的风险较高，包括精神病、其他神经系统疾病、糖尿病、甲状腺功能减退、类风湿性关节炎、胶原血管疾病、肥胖、体重减轻、液体和电解质紊乱、缺乏性贫血和瘫痪。性别和自闭症谱系障碍状态相互作用的结果表明，患有自闭症谱系障碍的女性院内死亡率几乎是患有自闭症谱系障碍的男性的两倍（比值比 = 1.95，p < 0.001）。分层分析结果还显示，与匹配对照组的非自闭症谱系障碍女性相比，患有自闭症谱系障碍女性的院内死亡率高出 3.17 倍（95% 置信区间：2.50-4.01，p < 0.001）；即使在调整了社会经济、临床和医院特征后，这种差异仍然存在（优势比 = 2.75，95% 置信区间：2.09-3.64，p < 0.001）。我们的研究结果强调需要进行更多研究，以制定更好的策略，为自闭症谱系障碍患者提供医疗保健和服务。
A retrospective data analysis using 2004-2014 Healthcare Cost and Utilization Project Nationwide Inpatient Sample was conducted to examine in-hospital mortality among adults with autism spectrum disorders in the United States compared to individuals in the general population. We modeled logistic regressions to compare inpatient hospital mortality between adults with autism spectrum disorders (n = 34,237) and age-matched and sex-matched controls (n = 102,711) in a 1:3 ratio. Adults with autism spectrum disorders had higher odds for inpatient hospital mortality than controls (odds ratio = 1.44, 95% confidence interval: 1.29-1.61, p < 0.001). This risk remained high even after adjustment for age, sex, race/ethnicity, income, number of comorbidities, epilepsy and psychiatric comorbidities, hospital bed size, hospital region, and hospitalization year (odds ratio = 1.51, 95% confidence interval: 1.33-1.72, p < 0.001). Adults with autism spectrum disorders who experienced in-hospital mortality had a higher risk for having 10 out of 27 observed Elixhauser-based medical comorbidities at the time of death, including psychoses, other neurological disorders, diabetes, hypothyroidism, rheumatoid arthritis collagen vascular disease, obesity, weight loss, fluid and electrolyte disorders, deficiency anemias, and paralysis. The results from the interaction of sex and autism spectrum disorders status suggest that women with autism spectrum disorders have almost two times higher odds for in-hospital mortality (odds ratio = 1.95, p < 0.001) than men with autism spectrum disorders. The results from the stratified analysis also showed that women with autism spectrum disorders had 3.17 times higher odds (95% confidence interval: 2.50-4.01, p < 0.001) of in-hospital mortality compared to women from the non-autism spectrum disorders matched control group; this difference persisted even after adjusting for socioeconomic, clinical, and hospital characteristics (odds ratio = 2.75, 95% confidence interval: 2.09-3.64, p < 0.001). Our findings underscore the need for more research to develop better strategies for healthcare and service delivery to people with autism spectrum disorders.