Socioeconomic inequality in the prevalence of autism spectrum disorder: evidence from a U.S. cross-sectional study.
Socioeconomic inequality in the prevalence of autism spectrum disorder: evidence from a U.S. cross-sectional study.
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DOI：
10.1371/journal.pone.0011551
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发表时间：
2010-07-12
期刊：
影响因子：
3.7
通讯作者：
Schieve LA
中科院分区：
文献类型：
--
作者：
Durkin MS;Maenner MJ;Meaney FJ;Levy SE;DiGuiseppi C;Nicholas JS;Kirby RS;Pinto-Martin JA;Schieve LA
本研究旨在评估美国儿童自闭症谱系障碍（ASD）的患病率与社会经济地位（SES）呈正相关的假设。一项横断面研究的数据来自自闭症和发育障碍监测网络，这是一个多源监测系统，结合了来自教育和医疗保健来源的数据，以确定特定人群中8岁ASD儿童的数量。2002年和2004年，在557 689名8岁儿童中，有3 680名自闭症儿童。地区级人口普查SES指标用于计算ASD患病率的SES三分位数的人口。患病率以剂量反应方式随着SES的增加而增加，低SES患者相对于中等SES的患病率为0.70（95%置信区间[CI] 0.64，0.76），高SES患者为1.25（95% CI 1.16，1.35）（P<0.001）。在按性别、种族/民族和监测数据来源分层的分析中，观察到有和无既存ASD诊断的儿童的SES梯度显著。与那些符合ASD标准但既往无ASD诊断记录的儿童相比，既有诊断的儿童SES梯度显著更强（p<0.001），并且在ASD和智力残疾并存的儿童中不存在。与没有预先存在的ASD诊断的儿童相比，ASD患病率的SES梯度更强，这表明可能存在确定或诊断偏倚，以及SES在自闭症儿童获得服务方面的差异。需要进一步研究，以确认和了解这种差异的来源，以便能够得出政策影响。还应考虑到可能存在与高SES和ASD易感性相关的因果机制或混杂因素的可能性。
This study was designed to evaluate the hypothesis that the prevalence of autism spectrum disorder (ASD) among children in the United States is positively associated with socioeconomic status (SES). A cross-sectional study was implemented with data from the Autism and Developmental Disabilities Monitoring Network, a multiple source surveillance system that incorporates data from educational and health care sources to determine the number of 8-year-old children with ASD among defined populations. For the years 2002 and 2004, there were 3,680 children with ASD among a population of 557 689 8-year-old children. Area-level census SES indicators were used to compute ASD prevalence by SES tertiles of the population. Prevalence increased with increasing SES in a dose-response manner, with prevalence ratios relative to medium SES of 0.70 (95% confidence interval [CI] 0.64, 0.76) for low SES, and of 1.25 (95% CI 1.16, 1.35) for high SES, (P<0.001). Significant SES gradients were observed for children with and without a pre-existing ASD diagnosis, and in analyses stratified by gender, race/ethnicity, and surveillance data source. The SES gradient was significantly stronger in children with a pre-existing diagnosis than in those meeting criteria for ASD but with no previous record of an ASD diagnosis (p<0.001), and was not present in children with co-occurring ASD and intellectual disability. The stronger SES gradient in ASD prevalence in children with versus without a pre-existing ASD diagnosis points to potential ascertainment or diagnostic bias and to the possibility of SES disparity in access to services for children with autism. Further research is needed to confirm and understand the sources of this disparity so that policy implications can be drawn. Consideration should also be given to the possibility that there may be causal mechanisms or confounding factors associated with both high SES and vulnerability to ASD.
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影响因子：
5
作者：
Durkin, Maureen S.;Maenner, Matthew J.;Newschaffer, Craig J.;Lee, Li-Ching;Cunniff, Christopher M.;Daniels, Julie L.;Kirby, Russell S.;Leavitt, Lewis;Miller, Lisa;Zahorodny, Walter;Schieve, Laura A.
通讯作者：
Schieve, Laura A.
影响因子：
3.9
作者：
Cryan, E;Byrne, M;OCallaghan, E
通讯作者：
OCallaghan, E
DOI：
10.1097/00004583-200107000-00017
发表时间：
2001-07-01
影响因子：
13.3
作者：
Fombonne, E;Simmons, H;Goodman, R
通讯作者：
Goodman, R
影响因子：
3.9
作者：
GILLBERG, C;SCHAUMANN, H
通讯作者：
SCHAUMANN, H
影响因子：
12.7
作者：
Mandell, David S.;Wiggins, Lisa D.;Kirby, Russell S.
通讯作者：
Kirby, Russell S.