Diagnostic change and the increased prevalence of autism
Diagnostic change and the increased prevalence of autism
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DOI：
10.1093/ije/dyp261
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发表时间：
2009-10-01
影响因子：
7.7
通讯作者：
Bearman, Peter
中科院分区：
文献类型：
--
作者：
King, Marissa;Bearman, Peter
背景孤独症患病率的增加已经引起了相当大的关注。然而，诊断方法的变化对患病率增加的贡献尚未得到彻底研究。关于诊断替代作用的争论也在继续。加州一直是这些争议中的一个重要案例。本研究的目的是确定在何种程度上增加患病率的自闭症在加州已被驱动的变化，诊断的做法，诊断替代和诊断accretion.Methods回顾性病例记录检查7003例出生于1987年之前的自闭症谁参加了加州发展服务部在1992年和2005年之间进行了。主要的兴趣是631例患者的唯一诊断精神发育迟滞（MR），随后获得了自闭症的诊断。感兴趣的结果是计算由于诊断实践的变化而获得自闭症诊断的概率。诊断变化的概率，然后使用模型的比例，自闭症病例所产生的诊断practices.Results的患者获得自闭症诊断的几率升高期间，诊断自闭症的做法改变。诊断实践发生变化的年份的变化几率为1.68 [95%置信区间（CI）1.11-2.54]、1.55（95% CI 1.03-2.34）、1.58（95% CI 1.05-2.39）、1.82（95% CI 1.23-2.7）和1.61（95% CI 1.09-2.39）。使用1992年至2005年之间的变化概率来概括自闭症人群，据估计，（95% CI 16.25-36.48），加州增加的自闭症病例数与诊断变化通过单一途径唯一相关-先前诊断患有MR的个体。结论诊断孤独症的实践的变化对孤独症病例量产生了实质性影响，占1992年至2005年期间加州观察到的患病率增加的四分之一。
Background Increased autism prevalence rates have generated considerable concern. However, the contribution of changes in diagnostic practices to increased prevalence rates has not been thoroughly examined. Debates over the role of diagnostic substitution also continue. California has been an important test case in these controversies. The objective of this study was to determine the extent to which the increased prevalence of autism in California has been driven by changes in diagnostic practices, diagnostic substitution and diagnostic accretion.Methods Retrospective case record examination of 7003 patients born before 1987 with autism who were enrolled with the California Department of Developmental Services between 1992 and 2005 was carried out. Of principal interest were 631 patients with a sole diagnosis of mental retardation (MR) who subsequently acquired a diagnosis of autism. The outcome of interest was the probability of acquiring a diagnosis of autism as a result of changes in diagnostic practices was calculated. The probability of diagnostic change is then used to model the proportion of the autism caseload arising from changing diagnostic practices.Results The odds of a patient acquiring an autism diagnosis were elevated in periods in which the practices for diagnosing autism changed. The odds of change in years in which diagnostic practices changed were 1.68 [95% confidence interval (CI) 1.11-2.54], 1.55 (95% CI 1.03-2.34), 1.58 (95% CI 1.05-2.39), 1.82 (95% CI 1.23-2.7) and 1.61 (95% CI 1.09-2.39). Using the probability of change between 1992 and 2005 to generalize to the population with autism, it is estimated that 26.4% (95% CI 16.25-36.48) of the increased autism caseload in California is uniquely associated with diagnostic change through a single pathway-individuals previously diagnosed with MR. Conclusion Changes in practices for diagnosing autism have had a substantial effect on autism caseloads, accounting for one-quarter of the observed increase in prevalence in California between 1992 and 2005.