Mortality in Autism

拟议项目的长期目标是降低过高的死亡率，提高预期寿命， 自闭症谱系障碍（ASD）患者。具体目标是：1）确定年龄和性别特异性 有和没有ASD的医疗补助受益人的死亡风险; 2）检查 有和没有ASD的医疗补助受益人; 3）识别效果调节剂（例如，性别和智力残疾） 与ASD相关的死亡风险; 4）评估医疗补助中死亡风险的种族和民族差异 有和没有ASD的受益人。据报道，在美国， 在过去二十年中，死亡率增加了两倍多，从2000年的每千人6.7人增加到23.0人。 2018年1000人。据估计，美国有690万ASD患者，其中包括超过150万人。 100万3-17岁儿童和540万18-84岁成人。作为一种复杂的神经发育 ASD患者通常需要广泛的终身医疗保健和社会服务。ASD的研究已经 主要集中在了解其生物学，确定风险因素，监测儿童的患病率， 评估治疗和干预措施。虽然患有糖尿病的人的预期寿命大大缩短， 自20世纪90年代初以来，ASD一直被推测，关于自闭症死亡率和寿命问题的研究仍然存在 少。医疗补助，包括儿童健康保险计划，是主要的公共保险计划 对于ASD患者来说。拟议的项目涉及建立一个约100万人的动态队列 患有ASD的医疗补助受益人和大约400万没有ASD的医疗补助受益人（200万匹配 与暴露队列的状态，入学年份，入学年龄和性别;和200万匹配 此外，还对合格性类型进行了分析，并分析了24年研究期间（1999-2022年）的纵向数据。 拟议项目的结果将为了解生活提供急需的流行病学证据， 病程死亡率风险、死亡原因、死亡率风险的影响因素以及 与ASD相关的死亡风险，以及制定有效的干预措施以降低过度死亡率， 为ASD患者提供健康政策和服务规划。

The long-term objective of the proposed project is to reduce excess mortality and improve life expectancy for people with autism spectrum disorder (ASD). The specific aims are to: 1) determine age- and sex-specific mortality risk in Medicaid beneficiaries with and without ASD; 2) examine cause-specific mortality risk in Medicaid beneficiaries with and without ASD; 3) identify effect modifiers (e.g., gender and intellectual disability) of mortality risk associated with ASD; and 4) assess racial and ethnic disparities in mortality risk in Medicaid beneficiaries with and without ASD. In the United States, the reported prevalence of ASD among children aged 8 years has more than tripled over the past two decades, increasing from 6.7 per 1,000 in 2000 to 23.0 per 1000 in 2018. There were an estimated 6.9 million persons with ASD in the United States, including over 1.5 million children aged 3-17 years and 5.4 million adults aged 18-84 years. As a complex neurodevelopmental disability, ASD often requires extensive lifetime health care and social services. Research on ASD has been largely concentrated in understanding its biology, identifying risk factors, monitoring prevalence in children, and evaluating treatments and interventions. Although substantially reduced life expectancy for individuals with ASD has been speculated since the early 1990s, research on mortality and lifespan issues in autism remains scant. Medicaid, including the Children’s Health Insurance Program, is the primary public insurance program for individuals with ASD. The proposed project involves constructing a dynamic cohort of about 1 million Medicaid beneficiaries with ASD and about 4 million Medicaid beneficiaries without ASD (two million matched with the exposed cohort on state, year of enrollment, age at enrollment, and sex; and two million matched additionally on type of eligibility) and analyzing longitudinal data over a 24-year study period (1999–2022). Results from the proposed project will provide much-needed epidemiologic evidence for understanding the life- course mortality risk, causes of death, effect modifiers of mortality risk, and racial and ethnic disparities in mortality risk associated with ASD, and for developing effective interventions to reduce excess mortality and informing health policy and service planning for people with ASD.