Study: Autism shaves an average of 14 years from life expectancy, with flu the leading contributor
Mary Van Beusekom, MSToday at 2:34 p.m.
Influenza, General
Pneumonia
Life expectancy for people diagnosed as having autism spectrum disorder (ASD) is 14 years less than for people without the condition, with influenza- and pneumonia-related death contributing to the gap, researchers from Columbia University and University of Colorado Anschutz report in JAMA Network Open.
For the study, published last week, the study team analyzed enhanced Medicaid data and linked National Death Index data for all US Medicaid beneficiaries from 2000 to 2020.
The authors noted that, until now, ASD research has focused primarily on biologic and genetic factors, biology, diagnosis, and assessment of treatments and interventions.
“Autism is a complex lifelong condition with substantial costs to the U.S. healthcare system,” lead author Guohua Li, DrPH, MD, of Columbia, said in a university news release. “Elevated mortality risk in people with ASD has been reported since late 1980s, but life expectancy for the autistic population remained unknown because of inadequate data on age-specific death rates.”
Greater life expectancy gap in women than in men
During the study period, more than two million people with ASD were enrolled in Medicaid. In total, 76.1% were men, 48.5% were White, 16.7% were Hispanic, 14.6% were Black, and 20.2% were another race.For Medicaid enrollees with ASD, life expectancy was 64.9 years—5.6 years shorter than for the overall Medicaid population and 13.8 years shorter than for the US general population. Life expectancy among participants with ASD varied little by sex (64.6 and 65.0 years for men and women, respectively) or race (64.9 years for Hispanic, 63.7 for Black, 64.8 for White, and 66.7 for other race).
But relative to autistic women, other female Medicaid beneficiaries lived 8.2 years longer, and those in the general US population lived 16.0 years longer. This deficit was greater than in autistic men, who lived 1.9 years less than other male Medicaid beneficiaries and 11.6 years less than men in the general population.
From 2000 to 2004 and 2015 to 2019, life expectancy for Medicaid beneficiaries with ASD rose 1.7 years (from 63.9 to 65.6 years), but the disparities between the Medicaid beneficiary population and the US general population stayed the same. In 2020, in the first year of the COVID-19 pandemic, life expectancy fell across all studied groups, with the largest reduction (4.1 years relative to 2015 to 2019) among autistic people.
Medicaid beneficiaries with ASD were at a 44% higher risk for death than other Medicaid beneficiaries.
Excess death among autistic Medicaid beneficiaries was observed in most disease categories and medical conditions but was most pronounced with flu (sex-standardized mortality ratio [SMR], 10.55), malnutrition (SMR, 7.56), pneumonitis due to inhalation of solids and liquids (SMR, 6.92), non-vehicle accidents (SMR, 4.48), drowning (SMR, 3.26), and pneumonia (SMR, 3.06).
Better social support and primary care can address deficits
“Compared with the general population, autistic women face a greater deficit in life expectancy than autistic men do, due to more psychiatric comorbidities and resulting excess mortality,” the authors wrote.Life expectancy for the autistic population enrolled in Medicaid in the United States is about 65 years, which is same as for the general population in Haiti or Angola.
Carolyn DiGuiseppi, MD, PhD
They cautioned that because Medicaid serves low-income people and those with disabilities, autistic beneficiaries are likely to have lower socioeconomic status and more severe symptoms than autistic people not enrolled in the program, which may predispose to bias that leads to underestimation of life expectancy.
Also, Medicaid beneficiaries with ASD are disproportionately children, young adults, and men compared with the reference populations, which raises concerns about bias from unmeasured confounding in SMRs.
“Life expectancy for the autistic population enrolled in Medicaid in the United States is about 65 years, which is same as for the general population in Haiti or Angola,” coauthor Carolyn DiGuiseppi, MD, PhD, at the University of Colorado said. “This finding is sobering.”
But Li noted that interventions are available that can reduce the mortality gap. “The good news is that much of the excess mortality among people with ASD is avoidable through improved social support, primary care, and home- and community-based services,” he said.