Health characteristics of reproductive-aged autistic women in Ontario: A population-based, cross-sectional study

Tint, Ami; Brown, Hilary K.; Chen, Simon; Lai, Meng‐Chuan; Tarasoff, Lesley A.; Vigod, Simone N.; Parish, Susan L.; Havercamp, Susan M.; Lunsky, Yona

doi:10.1177/1362361320982819

Cited by 17 publications

(12 citation statements)

References 72 publications

(97 reference statements)

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“…The present study fills current knowledge gaps as the findings are derived from a large, population-based sample of autistic women and men matched by age with adults with other DD and those without DD. Echoing a growing number of administrative data studies from other jurisdictions (Cawthorpe, 2017;Croen et al, 2015;Davignon et al, 2018;Hand et al, 2019;Smith DaWalt et al, 2021;Tint et al, 2021), we found that autistic women and men were more likely to have a wide variety of physical and mental health conditions and to use health services more compared to women and men without DD. There were some significant sex differences for specific physical (i.e.…”

Section: Discussionmentioning

confidence: 79%

“…A small but steadily increasing number of studies using administrative data demonstrate that autistic adults have elevated physical health and psychiatric conditions (Cawthorpe, 2017;Chiang et al, 2015;Croen et al, 2015;Davignon et al, 2018;Hand et al, 2019;Kohane et al, 2012;Schott et al, 2022aSchott et al, , 2022bSmith DaWalt et al, 2021;Tint et al, 2021;Tyler et al, 2011;Vohra et al, 2017;Weiss et al, 2018) and higher health service use rates (Ames et al, 2021;Hand et al, 2018;Smith DaWalt et al, 2021;Vohra et al, 2016Vohra et al, , 2017Weiss et al, 2018;Zerbo et al, 2019) compared to the general population. The majority of these studies, however, are comprised predominantly of young adult males (Cawthorpe, 2017;Chiang et al, 2015;Davignon et al, 2018;Kohane et al, 2012;Tyler et al, 2011;Weiss et al, 2018) and many do not include sex-stratified analyses to allow for an understanding of autistic women's patterns of need.…”

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confidence: 99%

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Health conditions and service use of autistic women and men: A retrospective population-based case–control study

Tint

Chung²,

Lai

et al. 2023

Autism

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This study used administrative data to compare the socio-demographics, health conditions, and health service use of autistic adults with adults with and without other developmental disabilities, after matching for age and sex. Autistic women and men were more likely to have a wide range of physical and mental health conditions compared to adults without developmental disabilities. Rates of co-occurring health conditions were similar or lower among autistic adults compared to adults with other developmental disabilities, except for a higher prevalence of psychiatric conditions among autistic adults. Notably increased psychiatric service use was evident among autistic women and men compared to the other groups. Among age-matched autistic women and men, significant differences were found for physical (i.e. Crohn’s disease/colitis, rheumatoid arthritis) and psychiatric conditions (i.e. psychotic disorders, non-psychotic disorders), as well as service use (i.e. emergency department visits, hospitalizations, family doctor and neurologist visits). These findings suggest autistic adults have high health care needs, as do adults with other developmental disabilities. Mental health support is especially critical for autistic adults and research examining sex and gender effects will assist in tailoring health promotion and intervention efforts. Lay abstract This study used administrative data from Ontario, Canada to compare the health conditions and service use of autistic women and men with adults with other developmental disabilities and with adults without developmental disabilities. Autistic women and men were more likely to have physical and mental health conditions compared to adults without developmental disabilities. Rates of health conditions were similar or lower among autistic adults compared to adults with other developmental disabilities, except more autistic adults had psychiatric conditions. Autistic women and men used higher rates of psychiatric services compared to all other groups. When comparing autistic women with same aged autistic men, sex differences were found for specific physical (Crohn’s disease/colitis, rheumatoid arthritis) and psychiatric conditions (psychotic disorders, non-psychotic disorders), as well differences in service use (emergency department visits, hospitalizations, family doctor and neurologist visits). These results further highlight the high health needs and service use of autistic women and men, as well as adults with other developmental disabilities. It is critical for future research to focus on mental health support for autistic adults and to better understand how to tailor supports to best serve autistic women.

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Section: Discussionmentioning

confidence: 79%

mentioning

confidence: 99%

Health conditions and service use of autistic women and men: A retrospective population-based case–control study

Tint

Chung²,

Lai

et al. 2023

Autism

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“…The use of cross‐sectional data also precludes causal inference or temporal sequence between the variables (Wang & Cheng, 2020). The generalizability of the findings may be limited by the specific characteristics of the study population and setting (Tint et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Impact of pubertal timing and socioeconomic status on adult height and body proportions in Igbo ethnicity

Sunday,

Elsie

2023

American J Hum Biol

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ObjectivesAge at menarche is a marker of pubertal timing that may influence adult height and body proportions. Previous studies have shown that socioeconomic status can affect age at menarche and growth patterns in different populations. This study aims to examine the associations between age at menarche, socioeconomic status, height, and leg length in a sample of Igbo ethnicity.MethodsThe study used data from questionnaires and anthropometric measurements of 300 female students aged 18–25 years. Study tested the hypotheses that earlier menarche is associated with shorter stature and shorter leg length, and that these associations are modified by socioeconomic status using nonparametric analysis.ResultsMean age at menarche was fluctuating around 12.84 ± 1.40 and 13.59 ± 1.41 years with school girls and grew 3.0 cm taller per year birth cohort. The study also found that girls with earlier menarche were shorter adult height (162.51 ± 6.00) compared with girls who have menarche at a later age. The linear regression coefficients (bs) ranged from 0.37–0.49 in later year birth cohort and 0.37–0.44 in early year birth cohort for height. The effect of age at menarche on leg length was similar to the relation between age at menarche and birth cohort height.ConclusionThe study will contribute to the understanding of how pubertal timing and socioeconomic status interact to shape adult health outcomes in a transitioning population.

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“…Autistic individuals were identified when autism diagnoses were recorded at 2 or more outpatient physician visits, 1 or more emergency department visit or same-day surgery, or 1 or more hospitalization, using codes from the International Classification of Diseases, Ninth Revision (code 299), International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) (codes F84.0, F84.1, F84.3, F84.5, F84.8, and F84.9), or Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (code 299), as a fixed-effect variable. This previously used algorithm 28 has excellent specificity and moderate sensitivity. 29 For self-harm events and suicide death we had different accrual and follow-up periods owing to data availability (see Outcome Measures).…”

Section: Study Design and Data Sourcesmentioning

confidence: 99%

Self-Harm Events and Suicide Deaths Among Autistic Individuals in Ontario, Canada

Lai

Saunders

Huang³

et al. 2023

JAMA Netw Open

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ImportanceReasons for elevated suicide risks among autistic people are unclear, with insufficient population-based research on sex-specific patterns to inform tailored prevention and intervention.ObjectivesTo examine sex-stratified rates of self-harm events and suicide death among autistic individuals compared with nonautistic individuals, as well as the associated sociodemographic and clinical risk factors.Design, Setting, and ParticipantsThis population-based matched-cohort study using linked health administrative databases in Ontario, Canada included all individuals with physician-recorded autism diagnoses from April 1, 1988, to March 31, 2018, each matched on age and sex to 4 nonautistic individuals from the general population. Self-harm events resulting in emergency health care from April 1, 2005, to December 31, 2020, were examined for one cohort, and death by suicide and other causes from April 1, 1993, to December 31, 2018, were examined for another cohort. Statistical analyses were conducted between October 2021 and June 2023.ExposurePhysician-recorded autism diagnoses from 1988 to 2018 from health administrative databases.Main Outcomes and MeasuresAutistic and nonautistic individuals who were sex stratified a priori were compared using Andersen-Gill recurrent event models on self-harm events, and cause-specific competing risk models on death by suicide or other causes. Neighborhood-level income and rurality indices, and individual-level broad diagnostic categories of intellectual disabilities, mood and anxiety disorders, schizophrenia spectrum disorders, substance use disorders, and personality disorders were covariates.ResultsFor self-harm events (cohort, 379 630 individuals; median age at maximum follow-up, 20 years [IQR, 15-28 years]; median age of first autism diagnosis claim for autistic individuals, 9 years [IQR, 4-15 years]; 19 800 autistic females, 56 126 autistic males 79 200 nonautistic females, and 224 504 nonautistic males), among both sexes, autism diagnoses had independent associations with self-harm events (females: relative rate, 1.83; 95% CI, 1.61-2.08; males: relative rate, 1.47; 95% CI, 1.28-1.69) after accounting for income, rurality, intellectual disabilities, and psychiatric diagnoses. For suicide death (cohort, 334 690 individuals; median age at maximum follow-up, 19 years [IQR, 14-27 years]; median age of first autism diagnosis claim for autistic individuals, 10 years [IQR, 5-16 years]; 17 982 autistic females, 48 956 autistic males, 71 928 nonautistic females, 195 824 nonautistic males), there was a significantly higher crude hazard ratio among autistic females (1.98; 95% CI, 1.11-3.56) and a nonsignificantly higher crude hazard ratio among autistic males (1.34; 95% CI, 0.99-1.82); the increased risks were associated with psychiatric diagnoses.Conclusions and RelevanceThis cohort study suggests that autistic individuals experienced increased risks of self-harm events and suicide death. Psychiatric diagnoses were significantly associated with the increased risks among both sexes, especially for suicide death, and in partially sex-unique ways. Autism-tailored and autism-informed clinical and social support to reduce suicide risks should consider multifactorial mechanisms, with a particular focus on the prevention and timely treatment of psychiatric illnesses.

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Health characteristics of reproductive-aged autistic women in Ontario: A population-based, cross-sectional study

Cited by 17 publications

References 72 publications

Health conditions and service use of autistic women and men: A retrospective population-based case–control study

Health conditions and service use of autistic women and men: A retrospective population-based case–control study

Impact of pubertal timing and socioeconomic status on adult height and body proportions in Igbo ethnicity

Self-Harm Events and Suicide Deaths Among Autistic Individuals in Ontario, Canada

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