Co‐occurring conditions and racial‐ethnic disparities: Medicaid enrolled adults on the autism spectrum

Abstract

Evidence suggests that autistic adults have higher odds of developing several co‐occurring conditions, but less is known about disparities by race and ethnicity in this population. Using 2008–2012 Medicaid Analytic eXtract (MAX) data, we (i) identify the prevalence of co‐occurring conditions among the population of autistic adult Medicaid beneficiaries compared to a matched sample of those without an autism spectrum disorder (ASD) diagnosis, (ii) conduct logistic regression to estimate odds ratios for these health conditions predicted by an autism diagnosis, and (iii) estimate odds of having these health conditions as predicted by racial/ethnic group among the autistic population only. Overall, autistic adults did not have higher prevalence of some major health conditions (cardiovascular conditions, stroke, cancer, cardiovascular disease), but they did have higher odds of others (nutrition conditions, epilepsy, disorders of the central nervous system). Analysis by racial/ethnic group, however, shows that Black, Hispanic, and Asian autistic beneficiaries had higher odds of diabetes, hospitalized cardiovascular diseases, and hypertension, among other conditions. Policymakers should be aware that racial disparities found in the general population persist in the autistic population and should work to implement systems and programs to improve screening and preventive care for minority autistic populations. Lay Summary Autistic adults may have several co‐occurring physical and mental health conditions, which could differ by racial/ethnic group. We find that, compared to the general Medicaid population, autistic adult Medicaid beneficiaries have elevated odds of some health conditions, like epilepsy and nutrition conditions, as well as some psychiatric conditions, such as anxiety and attention disorders. We also find that many of the same health disparities by racial/ethnic group in the general population persist among the autistic adult Medicaid population. For example, Black, Hispanic, and Asian Medicaid autistic beneficiaries have higher odds of diabetes, and Black and Hispanic autistic beneficiaries have higher odds of obesity and nutrition conditions than white autistic beneficiaries.

Evidence from the Autism Transitions Research Project (2017–2022): Capstone review and services research recommendations

“…Other notable aspects of the work not included in Table 1 capture issues of diversity and representation. Seven studies included an explicit focus on issues of equity based on race, ethnicity, gender, and income (Benevides et al, 2022; McGhee Hassrick et al, 2021; Roux et al, 2022; Schott et al, 2022a; Shattuck et al, 2020; Song, Nonnemacher, Miller, Anderson, & Shea, 2022; Song, Salzer, Nonnemacher, Miller, & Shea, 2022). One review article noted that under‐represented study participants included autistic individuals who were women, transgender, non‐White, low income, and those with intellectual disability or with minimal speaking communication (McGhee Hassrick et al, 2021).…”

“…Across domains (health, mental health, employment, etc. ), access, service use and outcomes varied by race/ethnicity, income, gender, and by intersections of these factors with autism diagnosis (Benevides et al, 2022; McGhee Hassrick et al, 2021; Roux et al, 2022; Schott et al, 2022a; Shattuck et al, 2020; Song, Nonnemacher, Miller, Anderson, & Shea, 2022; Song, Salzer, Nonnemacher, Miller, & Shea, 2022). Both service delivery and policy to support vocational programming varied widely across states with an evident lack of state planning for addressing the service needs of this growing population (Roux et al, 2019; Roux, Anderson, Rast, et al, 2018; Roux, Rast, Nye‐Lengerman, et al, 2018; Roux, Rast, & Shattuck, 2018).…”

Racial/Ethnic Differences in Psychiatric and Medical Diagnoses Among Autistic Adults

“… 19 However, our findings are somewhat consistent with two studies that identified racial/ethnic health disparities among autistic adults and adults with IDD more generally. 31 , 62 In Medicaid data, Black, Hispanic, and Asian/Pacific Islander autistic beneficiaries tended to be less frequently diagnosed with mental health conditions, with the exception of schizophrenia, and more frequently diagnosed with several medical conditions including hypertension and diabetes in comparison with White autistic counterparts. 62 …”

“… 31 , 62 In Medicaid data, Black, Hispanic, and Asian/Pacific Islander autistic beneficiaries tended to be less frequently diagnosed with mental health conditions, with the exception of schizophrenia, and more frequently diagnosed with several medical conditions including hypertension and diabetes in comparison with White autistic counterparts. 62 …”

“…Although these findings warrant closer attention, they were not replicated in a larger sample using Medicaid data. 62 Nevertheless, future studies can expand this intersectional framework to also consider disparities in mortality and morbidity stemming from these conditions. Research suggests that inequities in care and delayed diagnosis may contribute to faster disease progression and elevated risk of severe disease and health complications, such as has been seen with hypertension, autoimmune diseases, and sleep disorders among Black adults in the general U.S. population.…”