The spatial distribution of known predictors of autism spectrum disorders impacts geographic variability in prevalence in central North Carolina
- Kate HoffmanAffiliated withGillings School of Global Public Health, University of North Carolina Email author
- , Amy E KalkbrennerAffiliated withGillings School of Global Public Health, University of North CarolinaZilber School of Public Health, University of Wisconsin at Milwaukee
- , Veronica M VieiraAffiliated withBoston University School of Public HealthSchool of Ecology, University of California
- , Julie L DanielsAffiliated withGillings School of Global Public Health, University of North Carolina
The causes of autism spectrum disorders (ASD) remain largely unknown and widely debated; however, evidence increasingly points to the importance of environmental exposures. A growing number of studies use geographic variability in ASD prevalence or exposure patterns to investigate the association between environmental factors and ASD. However, differences in the geographic distribution of established risk and predictive factors for ASD, such as maternal education or age, can interfere with investigations of ASD etiology. We evaluated geographic variability in the prevalence of ASD in central North Carolina and the impact of spatial confounding by known risk and predictive factors.
Children meeting a standardized case definition for ASD at 8 years of age were identified through records-based surveillance for 8 counties biennially from 2002 to 2008 (n=532). Vital records were used to identify the underlying cohort (15% random sample of children born in the same years as children with an ASD, n=11,034), and to obtain birth addresses. We used generalized additive models (GAMs) to estimate the prevalence of ASD across the region by smoothing latitude and longitude. GAMs, unlike methods used in previous spatial analyses of ASD, allow for extensive adjustment of individual-level risk factors (e.g. maternal age and education) when evaluating spatial variability of disease prevalence.
Unadjusted maps revealed geographic variation in surveillance-recognized ASD. Children born in certain regions of the study area were up to 1.27 times as likely to be recognized as having ASD compared to children born in the study area as a whole (prevalence ratio (PR) range across the study area 0.57-1.27; global P=0.003). However, geographic gradients of ASD prevalence were attenuated after adjusting for spatial confounders (adjusted PR range 0.72-1.12 across the study area; global P=0.052).
In these data, spatial variation of ASD in central NC can be explained largely by factors impacting diagnosis, such as maternal education, emphasizing the importance of adjusting for differences in the geographic distribution of known individual-level predictors in spatial analyses of ASD. These results underscore the critical importance of accounting for such factors in studies of environmental exposures that vary across regions.
KeywordsAutism spectrum disorders (ASD) Intellectual disability (ID) Spatial analysis Disease mapping Generalized additive models (GAMs) Geographic information systems (GIS)
- The spatial distribution of known predictors of autism spectrum disorders impacts geographic variability in prevalence in central North Carolina
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
- Online Date
- October 2012
- Online ISSN
- BioMed Central
- Additional Links
- Autism spectrum disorders (ASD)
- Intellectual disability (ID)
- Spatial analysis
- Disease mapping
- Generalized additive models (GAMs)
- Geographic information systems (GIS)
- Author Affiliations
- 1. Gillings School of Global Public Health, University of North Carolina, CB #7435, Chapel Hill, NC, 27599, USA
- 2. Zilber School of Public Health, University of Wisconsin at Milwaukee, 3230 E. Kenwood Blvd, Milwaukee, WI, 53211, USA
- 3. Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
- 4. School of Ecology, University of California, Irvine, CA, 92617, USA