A Scoping Review of Health Disparities in Autism Spectrum Disorder
Individuals with autism spectrum disorder (ASD) experience increased morbidity and decreased life expectancy compared to the general population, and these disparities are likely exacerbated for those individuals who are otherwise disadvantaged. We conducted a review to ascertain what is known about health and health system quality (e.g., high quality care delivery, adequate care access) disparities in ASD. Nine studies met final inclusion criteria. Seven studies identified racial disparities in access to general medical services for children with ASD. No studies examined disparities in health outcomes or included older adults. We present a model of health disparities (Fundamental Causes Model) that guides future research. Additional work should examine health disparities, and their causal pathways, in ASD, particularly for older adults.
KeywordsHealth Morbidity Costs Disparities Race Ethnicity
This project was supported by awards from the National Institute on Minority Health and Health Disparities (R01MD010243 [PI Kind]) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U54 HD090256 [PI Messing]; T32HD007489 [PI Mailick]) of the National Institutes of Health. This material is the result of work also supported with the resources and the use of facilities at the William S Middleton Memorial Veterans Hospital Geriatric Research, Education and Clinical Center in Madison, WI, the University of Wisconsin Department of Medicine, and the Waisman Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health nor the US Department of Veterans Affairs.
LBF conceptualized the manuscript and research questions, performed the initial article search, reviewed all articles identified by the search, wrote the initial draft of the manuscript, and revised the manuscript to address reviewer comments. AJHK participated in the formulation of the research questions, helped to finalize the list of included studies, and participated in the manuscript development and revisions.
Lauren Bishop-Fitzpatrick has received research funding from Autism Speaks and the National Institutes of Health. Amy J. H. Kind has received research support from the National Institutes of Health, the Centers for Medicare and Medicaid Services, the US Department of Veterans Affairs, and the John A. Hartford Foundation.
Compliance with Ethical Standards
This article does not contain any studies with human participants performed by any of the authors.
- Esbensen, A. J., Greenberg, J. S., Seltzer, M. M., & Aman, M. G. (2009). A longitudinal investigation of psychotropic and non-psychotropic medication use among adolescents and adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(9), 1339–1349.CrossRefPubMedPubMedCentralGoogle Scholar
- Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2(3), 217–250.Google Scholar
- Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5(69), 1–9.Google Scholar
- Li, Z., Tang, J., Li, H., Chen, S., He, Y., Liao, Y., et al. (2014). Shorter telomere length in peripheral blood leukocytes is associated with childhood autism. Scientific Reports, 4(7073), 1–6.Google Scholar
- Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 80–94.Google Scholar
- Liptak, G. S., Benzoni, L. B., Mruzek, D. W., Nolan, K. W., Thingvoll, M. A., Wade, C. M., et al. (2008). Disparities in diagnosis and access to health services for children with autism: Data from the National Survey of Children’s Health. Journal of Developmental and Behavioral Pediatrics, 29(3), 152–160. doi: 10.1097/DBP.0b013e318165c7a0.CrossRefPubMedGoogle Scholar
- Magaña, S., Parish, S. L., Rose, R. A., Timberlake, M., & Swaine, J. G. (2012). Racial and ethnic disparities in quality of health care among children with autism and other developmental disabilities. Intellectual and Developmental Disabilities, 50(4), 287–299. doi: 10.1352/1934-9556-50.4.287.CrossRefPubMedGoogle Scholar
- Magaña, S., Parish, S. L., & Son, E. (2015). Have racial and ethnic disparities in the quality of health care relationships changed for children with developmental disabilities and ASD? American Journal on Intellectual and Developmental Disabilities, 120(6), 504–513. doi: 10.1352/1944-7558-120.6.504.CrossRefPubMedGoogle Scholar
- Nguyen, C. T., Krakowiak, P., Hansen, R., Hertz-Picciotto, I., & Angkustsiri, K. (2016). Sociodemographic disparities in intervention service utilization in families of children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(12), 3729–3738. doi: 10.1007/s10803-016-2913-3.CrossRefPubMedGoogle Scholar
- Nikolov, R. N., Bearss, K. E., Lettinga, J., Erickson, C., Rodowski, M., Aman, M. G., et al. (2009). Gastrointestinal symptoms in a sample of children with pervasive developmental disorders. Journal of Autism and Developmental Disorders, 39(3), 405–413. doi: 10.1007/s10803-008-0637-8.CrossRefPubMedGoogle Scholar
- Parish, S., Magaña, S., Rose, R., Timberlake, M., & Swaine, J. G. (2012). Health care of Latino children with autism and other developmental disabilities: Quality of provider interaction mediates utilization. American Journal on Intellectual and Developmental Disabilities, 117(4), 304–315. doi: 10.1352/1944-7558-117.4.304.CrossRefPubMedGoogle Scholar
- Romero, M., Aguilar, J. M., Del-Rey-Mejías, Á., Mayoral, F., Rapado, M., Peciña, M., et al. (2016). Psychiatric comorbidities in autism spectrum disorder: A comparative study between DSM-IV-TR and DSM-5 diagnosis. International Journal of Clinical and Health Psychology, 16(3), 266–275.CrossRefGoogle Scholar
- Starkstein, S., Gellar, S., Parlier, M., Payne, L., & Piven, J. (2015). High rates of parkinsonism in adults with autism. Journal of Neurodevelopmental Disorders, 7(29), 1–15.Google Scholar
- Susser, M., Watson, W., & Hopper, K. (1985). Sociology in medicine. New York: Oxford University Press.Google Scholar