Sex differences in the age of childhood autism diagnosis and the impact of co-occurring conditions.
Sex differences in the age of childhood autism diagnosis and the impact of co-occurring conditions.
复制标题
儿童自闭症诊断年龄的性别差异以及并发疾病的影响。
DOI：
10.1002/aur.3043
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Engelhard,Matthew
中科院分区：
文献类型：
--
作者：
Gu,Zhengyi;Dawson,Geraldine;Engelhard,Matthew
儿童时期自闭症诊断年龄的性别差异一直被记录在案，但仍然知之甚少。在这项研究中，我们使用了来自一个多样化的学术医疗中心的电子健康记录数据来量化男孩和女孩之间自闭症诊断年龄的差异，并确定诊断年龄与共同发生的神经发育，精神病和医疗条件之间的关联。一种已建立的可计算表型被用于识别2014年至2021年期间杜克大学卫生系统内的所有自闭症诊断。在自闭症诊断前2年内确定了共同发生的神经发育和精神病诊断以及特定医疗和支持服务的访问。拟合考克斯比例风险模型，以量化诊断年龄和性别之间的相关性，同时控制和不控制每种共发诊断和访视类型的存在。包括1438名个体（1142名男孩和296名女孩）的记录。女孩在3岁之前（= 497.720，p < 0.001）或11岁之后（= 4.014，p = 0.047）更容易被诊断，而男孩在3 - 11岁之间更容易被诊断（= 5.532，p = 0.019）。焦虑（= 4.200，p = 0.040）和情绪障碍（= 7.033，p = 0.008）在女孩中更常见，并且与后来的自闭症诊断相关（HR = 0.615，p < 0.001; HR = 0.493，p < 0.001）。男孩中耳鼻喉科就诊更常见，且与早期自闭症诊断相关（HR = 1.691，p < 0.001）。在控制这些条件后，性别和诊断年龄之间的关联降低，没有统计学意义。这些结果表明，与男孩相比，女孩的自闭症诊断年龄不同，但当控制自闭症诊断前同时发生的神经发育和精神疾病时，这些差异被抵消。了解性别差异和其他诊断可能的中介作用，可以建议干预目标，以促进更早和更公平的诊断。
Sex differences in the age of autism diagnosis during childhood have been documented consistently but remain poorly understood. In this study, we used electronic health records data from a diverse, academic medical center to quantify differences in the age of autism diagnosis between boys and girls and identify associations between the age of diagnosis and co‐occurring neurodevelopmental, psychiatric, and medical conditions. An established computable phenotype was used to identify all autism diagnoses within the Duke University Health System between 2014 and 2021. Co‐occurring neurodevelopmental and psychiatric diagnoses as well as visits to specific medical and supportive services were identified in the 2 years prior to the autism diagnosis. Cox proportional hazards models were fitted to quantify associations between diagnosis age and sex with and without controlling for the presence of each co‐occurring diagnosis and visit type. Records from 1438 individuals (1142 boys and 296 girls) were included. Girls were more likely to be diagnosed either before age 3 (= 497.720,p< 0.001) or after age 11 (= 4.014,p= 0.047), whereas boys were more likely to be diagnosed between ages 3 and 11 (= 5.532,p= 0.019). Visits for anxiety (= 4.200,p= 0.040) and mood disorders (= 7.033,p= 0.008) were more common in girls and associated with later autism diagnosis (HR = 0.615,p< 0.001; and HR = 0.493,p< 0.001). Visits for otolaryngology were more common in boys and associated with an earlier autism diagnosis (HR = 1.691,p< 0.001). After controlling for these conditions, associations between sex and diagnosis age were reduced and not statistically significant. These results show that the age of autism diagnosis differs in girls compared to boys, but these differences were neutralized when controlling for co‐occurring neurodevelopmental and psychiatric conditions prior to autism diagnosis. Understanding sex differences and the possible mediating role of other diagnoses may suggest targets for intervention to promote earlier and more equitable diagnosis.