Comprehensive Description of Comorbidity for Autism Spectrum Disorder in a General Population

Abstract

Context: Few published studies of autism spectrum disorder (ASD) and comorbidity are population based.Objective: To describe the comorbidity of ASD and disorders listed in the main classes of the International Classification of Diseases, Ninth Revision (ICD-9) in a general population.Design: Direct physician billing data for the city of Calgary, Alberta, Canada, for the treatment of any presenting concern in the Calgary Health Zone (n = 763,449) from 1994 to 2009 were extracted. Diagnosed ICD-9 disorders (independent variable) were grouped into 17 categories using ICD-9 diagnosis codes. ASD (dependent variable) was classified under ICD-9 Code 299. Individuals with and without independent disorder classes were counted by the presence or absence of any ASD. Odds ratios (ORs) and 95% confidence intervals of the association were calculated.Main Outcome Measures: ORs of ASD comorbidities. Results: Annual rates of ASD increased 3.9-fold for males and 1.4-fold for females. Diagnosed disorders ranked by OR in the independent ICD-9 categories indicated that males with ASD had overall higher ORs (> 1.0) in 11 main ICD-9 classes, and females with ASD had higher ORs (> 1.0) in 12 main ICD-9 classes. Males with ASD had lower ORs in 4 main ICD-9 disease classes; females with ASD had lower ORs related only to the main class "complications of pregnancy and childbirth." Five main ICD-9 classes were not significant for males or females.Conclusions: Patients with ASD have significant comorbidity of physical disorders. This finding may inform other areas of research and assessment in clinical management.

A 16-Year Cohort Analysis of Autism Spectrum Disorder-Associated Morbidity in a Pediatric Population

“…Definition of morbidity, for the purpose of this paper, required extension to include the concept of temporality and associated transient diseases or disorders, not necessarily present at the time of index ASD diagnosis, yet present at some past or future time in proportions greater than that expected by chance alone. The present study extends previous work on ASD ( 28 ) in describing the full range of unique International Classification of Diseases (ICD) diagnoses associated in time with ASD.…”

Pregnancy outcomes in women with autism: a nationwide population-based cohort study

“…Studies have proposed preeclampsia, labor induction, and SGA as risk factors for autism in offspring. 5 , 20 , 31 – 33 Since autism is a highly inherited disease with only partial penetrance, it is possible that preeclampsia, labor induction, and SGA are signs of overlapping inheritance.…”

“… 2 The etiology of autism is still not fully known, but risk factors include genetic predisposition, structural brain abnormalities with different causes, and physiological and biochemical dysfunction. 3 Individuals with autism suffer from increased comorbidity (eg, epilepsy and attention-deficit/hyperactivity disorder [ADHD], as well as other psychiatric and somatic disorders) 2 , 4 , 5 and are often treated with psychotropic and antiepileptic drugs. These drugs, when used during pregnancy are associated with adverse outcomes, such as preterm birth, abnormal birth weight, and poor neonatal adaptation.…”

High Functioning Autism Spectrum Disorders in Adults: Consequences for Primary Caregivers Compared to Schizophrenia and Depression

“…Recent studies (Buck et al 2014 ; Cawthorpe 2017 ; De-la-Iglesia and Olivar 2015 ; Hofvander et al 2009 ; Orinstein et al 2015 ; Cadman et al 2012 ) suggest that co-morbid psychiatric conditions (e.g. depression) make life more difficult especially for adults with HF-ASD.…”