Causes of Death in Autism

Abstract

The objective of this study was to determine which causes of death are more frequent in persons with autism, and by how much, compared with the general population. Subjects were 13,111 ambulatory Californians with autism, followed between 1983 and 1997. The units of study were person-years, each linked to the subject's age, sex, and cause of death (if any) for the specific year. Observed numbers of cause-specific deaths were compared with numbers expected according to general population mortality rates. Standardized mortality rates (SMRs) were computed for each mental retardation level. Elevated death rates were observed for several causes, including seizures and accidents such as suffocation and drowning; elevated mortality due to respiratory disease was observed among persons with severe mental retardation. Overall, excess mortality was especially marked for persons with severe mental retardation, but life expectancy is reduced even for persons who are fully ambulatory and who have only mild mental retardation.

This is a preview of subscription content, log in to check access.

REFERENCES

  1. Ackerman, M. J., Tester, D. J., & Porter, C. J. (1999). Swimming: A gene-specific arrhythmogenic trigger for inherited long QT syndrome. Mayo Clinic Proceedings, 74(11), 1088–1094.

    PubMed  Google Scholar 

  2. Ackerman, M. J., Tester, D. J., & Driscoll, D. J. (2001). Molecular autopsy of sudden unexplained death in the young. The American Journal of Forensic Medicine and Pathology, 22(2), 105–111.

    PubMed  Google Scholar 

  3. Andreassen, M. D., & Pedersen, S. (2000). Malignant neuroleptic syndrome: A review of epidemiology, risk factors, diagnosis, differential diagnosis and pathogenesis of MNS. Ugeskr Laeger, 162(10), 1366–1370.

    PubMed  Google Scholar 

  4. Annegers, J. F., & Coan, S. P. (1999). SUDEP: Overview of definitions and review of incidence data. Seizure, 8, 347–352.

    PubMed  Google Scholar 

  5. Arias, M., Ito, E., & Takagi, N. (1983). Concurrent validity of the client development and evaluation report. In Silverstein, A. B. & Fluharty, A. L. (Eds.), Pacific State Archives VIII, (pp. 28–33), Pomona, CA: University of California at Los Angeles, Developmental Disabilities Immersion Program.

    Google Scholar 

  6. Client Development Evaluation Report. (1978). Sacramento: California Department of Developmental Services.

  7. Chiang, C. E., & Roden, D. M. (2000). The long QT syndromes: Genetic basis and clinical implications. Journal American College of Cardiology, 36(1), 1–12.

    Google Scholar 

  8. De Ponti, F., Poluzzi, E., & Montanaro, N. (2001). Organizing evidence on QT prolongation and occurrence of torsades de pointes with non-antiarrhythmic drugs: A call for consensus. European Journal of Clinical Pharmacology, 57(3), 185–209.

    PubMed  Google Scholar 

  9. Ficker, D. M., So, E. L., Chen, W. K., Annegers, J. F., O'Brian, P. C., Cascine, G. D., & Belau, P. G. (1998). Population-based study of the incidence of sudden unexplained death in epilepsy. Neurology, 51(5), 1270–1274.

    PubMed  Google Scholar 

  10. Harris, C. W., Eyman, R. K., & Mayeda, T. (1982). An Interrater Reliability Study of the Client Development Evaluation Report: Final Report to the California Department of Developmental Disabilities. Los Angeles, CA: UCLA Mental Retardation Research Center, Lanterman State Hospital.

    Google Scholar 

  11. Gillberg, C. (1991). Outcome in autism and autistic-like conditions. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 375–382.

    PubMed  Google Scholar 

  12. ICD-9-CM (1995). Context Software Systems, Inc. The international classification of diseases, 9th Revision, Clinical Modification (4th ed.), New York: McGraw-Hill.

    Google Scholar 

  13. Kahn, H. A., & Sempos, C. T. (1989). Statistical methods in epidemiology. Oxford: Oxford University Press.

    Google Scholar 

  14. Kahn, M., & Farver, D. (2000). Recognition, assessment and management of neuroleptic malignant syndrome. South Dakota Journal of Medicine, 53, 395–400.

    PubMed  Google Scholar 

  15. Lilienfeld, A. M., & Lilienfeld, D. E. (1980). Foundations of epidemiology (2nd ed.), New York: Oxford University Press.

    Google Scholar 

  16. Maltby, J. (2000). The cost of autism: More than meets the eye. Advocate, November-December, 13–16.

  17. Paffenbarger, R. S., Hyde R. T., Wing A. L., & Hsieh, C. C. (1986). Physical activity, all-cause mortality, and longevity of college alumni. New England Journal of Medicine, 314, 605–613.

    PubMed  Google Scholar 

  18. Paffenbarger, R. S., Hyde, R. T., Wing, A. L., Lee, I. M., Jung, D. L., & Kampert, J. B. (1993). The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. New England Journal of Medicine, 328, 538–545.

    PubMed  Google Scholar 

  19. Shavelle, R. M., & Strauss, D. J. (1998). Comparative mortality of persons with autism in California, 1980–1996. Journal of Insurance Medicine, 30, 220-225.

    PubMed  Google Scholar 

  20. Shavelle, R. M., Strauss, D. J., & Pickett, J. A. (2001). Listing of causes of death of persons with autism in California, 1983–1987. http://www.LifeExpectancy.com/autism.html.

  21. State of California (1983–1997). Annual Mortality Tapes, 1983-1997. Department of Health Services, Center for Health Statistics, Office of Health Information and Research. Sacramento, CA.

    Google Scholar 

  22. State of California, Department of Finance (1988). Race/ethnic population with age and sex detail, 1970–2040. Sacramento, CA: Author.

    Google Scholar 

  23. Strauss, D. J., & Shavelle, R. M. (1999). Life expectancy of adults with cerebral palsy. Developmental Medicine and Child Neurology, 40, 369–375.

    Google Scholar 

  24. Strauss, D. J., Cable, W., & Shavelle, R. M. (1999). Causes of excess mortality in cerebral palsy. Developmental Medicine and Child Neurology, 41, 580–585.

    PubMed  Google Scholar 

  25. Strauss, D. J., Shavelle, R. M., & Anderson T. W. (1998a). Life expectancy of children with cerebral palsy. Pediatric Neurology, 18, 143–149.

    PubMed  Google Scholar 

  26. Strauss, D. J., Shavelle, R. M., & Anderson, T. W. (1998b). Long-term survival of children and adolescents after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 79, 1095–1100.

    PubMed  Google Scholar 

  27. Tuchman, R. (2000). Treatment of seizure disorders and EEG abnormalities in children with autistic spectrum disorders. Journal of Autism and Developmental Disorders, 30, 485–489.

    PubMed  Google Scholar 

  28. Wang, Q., Bowles, N. E., & Towbin, J. A. (1998). The molecular basis of long QT syndrome and prospects for therapy. Molecular Medicine Today, 4(9), 382–388.

    PubMed  Google Scholar 

  29. Widaman, K. F. (1984). Interrater reliability of adaptive behavior assessments: Item and factor levels. Presented at the 92nd Annual Meeting of the American Psychological Association, Toronto, Ontario, Canada.

  30. Widaman, K. F., Stacy, A. W., & Borthwick, S. A. (1985). Multitrait-multimethod of evaluating adaptive and maladaptive behavior of mentally retarded people. Presented at the 109th Annual Meeting of the American Association on Mental Deficiency, Philadelphia, Penn.

Download references

Author information

Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Shavelle, R.M., Strauss, D.J. & Pickett, J. Causes of Death in Autism. J Autism Dev Disord 31, 569–576 (2001). https://doi.org/10.1023/A:1013247011483

Download citation

  • Autism
  • PDD
  • cause of death
  • life expectancy
  • mental retardation level
  • mortality
  • standardized mortality ratio