Comorbidity and health services' usage in children with autism spectrum disorder: a nested case–control study

Abstract

Aims Children with autism spectrum disorder (ASD) tend to suffer from various medical comorbidities. We studied the comorbidity burden and health services' utilisation of children with ASD to highlight potential aetiologies and to better understand the medical needs of these children. Methods In this nested case–control study, ASD cases and controls – matched by age, sex and ethnicity in a 1:5 ratio – were sampled from all children born between 2009 and 2016 at a tertiary medical centre. Data were obtained from the hospital's electronic database. Comorbid diagnoses were classified according to pathophysiological aetiology and anatomical/systemic classification of disease. Standard univariate and multivariate statistics were used to demonstrate comorbidities and health services' utilisation patterns that are significantly associated with ASD. Results ASD children had higher rates of comorbidities according to both pathophysiological and anatomical/systemic classifications (p < 0.001). The most marked significant differences were observed for: hearing impairments (OR = 4.728; 95% CI 2.207–10.127) and other auricular conditions (OR = 5.040; 95% CI 1.759–14.438); neurological (OR = 8.198; 95% CI 5.690–11.813) and ophthalmological (OR = 3.381; 95% CI 1.617–7.068) conditions; and ADD/ADHD (OR = 3.246; 95% CI 1.811–5.818). A subgroup analysis revealed a more profound case–control difference in anaemia rates among girls than in boys (OR = 3.25; 95% CI 1.04–10.19 v. OR = 0.74; 95% CI 0.33–1.64 respectively) and an opposite trend (larger differences in males than in females in cardiovascular diseases (OR = 1.99; 95% CI 1.23–3.23 v. OR = 0.76; 95% CI 0.17–3.45, respectively)). In addition, larger case–control differences were seen among Bedouin children than in Jewish children in a number of medical comorbidities (Breslow–Day test for homogeneity of odds ratio p-value <0.05). Finally, we found that children with ASD tended to be referred to the emergency department and to be admitted to the hospital more frequently than children without ASD, even after adjusting for their comorbidity burden (aOR = 1.28; 95% CI 1.08–1.50 and aOR = 1.28; 95% CI 1.11–1.47 for >1 referrals and admissions per year, respectively). Conclusions The findings of this study contribute to the overall understanding of comorbid conditions and health services' utilisation for children with ASD. The higher prevalences of comorbidities and healthcare services' utilisation for children with ASD highlight the additional medical burden associated with this condition.

Identifying Children and Youth With Autism Spectrum Disorder in Electronic Medical Records: Examining Health System Utilization and Comorbidities

“…Further contributing to this heterogeneity is the observation that individuals with ASD also commonly have a range of comorbid conditions. These include other NDDs (e.g., attention deficit hyperactivity disorder [ADHD] [Dizitzer et al, 2020; Lai et al, 2019], obsessive compulsive disorder [OCD] [Lai et al, 2019; van Steensel, Bogels, & de Bruin, 2013]), and multiple psychiatric conditions (e.g., anxiety, depression [Kirsch et al, 2020; Lai et al, 2019; van Steensel et al, 2013], schizophrenia [Houghton, Ong, & Bolognani, 2017; Kirsch et al, 2020; Lai et al, 2019], and bipolar disorder [Kirsch et al, 2020; Lai et al, 2019]). Individuals with ASD are also more likely to be diagnosed with a host of other medical conditions including epilepsy [Lukmanji et al, 2019], gastrointestinal disturbances [Brondino et al, 2019; Dizitzer et al, 2020; Lee et al, 2018], sleep disorders [Croen et al, 2015], diabetes [Croen et al, 2015; Flygare Wallén, Ljunggren, Carlsson, Pettersson, & Wändell, 2018], hypertension [Croen et al, 2015; Flygare Wallén et al, 2018], and respiratory diseases [Cawthorpe, 2017] among others.…”

“…The increased burden of comorbid conditions makes meeting the needs of these patients more complex, and corresponds to increased health system utilization compared to the general population [Dizitzer et al, 2020]. In fact, patterns of comorbidities have been shown to identify subgroups of ASD with distinct clinical trajectories.…”

Rationale of an Advanced Integrative Approach Applied to Autism Spectrum Disorder: Review, Discussion and Proposal

“…One of the most cited problems has been the confounding role of the intellectual disability (ID). This group also has increased the number of CMPD in ASD [3,8]. A selection bias to study people with ASD without ID was shown [68,69].…”

“…Recent manuscripts reviewed the so-called comorbidities in ASD [4,5]. Comorbidities may be psychiatric [6], neurological [7], or related to medical conditions beyond the brain in the field of Pediatrics or General Medicine [8]. Recent literature has demonstrated that people with ASD diagnosis may have multiple comorbidities in different combinations and severity [9] and even temporal, transient hyper-multimorbidity.…”

Melatonin and Sleep Problems in Children with Autism Spectrum Disorder

“…The prevalence of ASD is estimated to be 1.7-1.85% of children and adolescents [1][2][3]. Children with ASD have a variety of comorbidities that affect their functioning during their daily lives [4]. Especially, sleep disturbances are relatively common and affect not only the daily functioning and quality of life of children but also the quality of life of their family [5][6][7][8].…”