Increased rates of chronic physical health conditions across all organ systems in autistic adolescents and adults

Abstract

Background The poorer physical health of autistic adults compared to non-autistic adults has been highlighted by several epidemiological studies. However, research has so far been limited to specific geographical areas and has primarily focused on young autistic individuals (aged 35 years and younger). Recent studies indicate a higher rate of mortality in autistic people, as well as poorer quality of self-reported healthcare interactions. This study aims to determine, first, whether autistic people experience greater levels of non-communicable health conditions and second, whether these are explained by differences in demographics (i.e. sex, country of residence, ethnicity, education level), alcohol use, smoking, body mass index (BMI), or family history of medical conditions. Method We employed a cross-sectional, convenience-sampling study via an anonymous, online survey of autistic and non-autistic adults (n = 2305, mean age = 41.6, 65.9% female, 49% autistic). The survey asked participants to self-report information about their demographics, autism diagnosis, diet, exercise, sleep, sexual health, substance use, personal medical history, and family medical history (for all first-degree, biological relatives). Binomial logistic regression across four iterative models of increasing complexity was applied to assess rates of physical health conditions. The Benjamini–Hochberg correction was used to account for multiple testing, and only physical health conditions that achieved at least 1% endorsement within the overall sample (n > 22) were included in the analysis to reduce risk of Type I errors. We also used novel network analysis methods to test whether there are increased levels of multimorbidity between autistic and non-autistic people. Results There were significantly elevated rates of non-communicable conditions across all organ systems in autistic people, including gastrointestinal, neurological, endocrine, visual, ear/nose/throat, skin, liver and kidney, and haematological conditions. We confirmed previous findings by showing highly significant differences in rates of neurological and gastrointestinal symptoms (p < 0.0001). In addition, we established in the largest sample to date that Ehler-Danlos Syndrome (EDS) was more likely to occur among autistic females compared to non-autistic females. Finally, we found a higher prevalence of Coeliac’s disease among autistic individuals compared to non-autistic individuals after controlling for sex, ethnicity, country of residence, alcohol use, smoking, and BMI, but these results became non-significant after accounting for family history. Limitations Our study is biased towards females, white individuals, highly educated people, and UK residents, likely due to sampling biases. Our self-report study design may also exclude those who lack access to computers, or those with intellectual disability. Our network analysis is also limited in size. Conclusions This study provides evidence of widespread, physical health comorbidity that spans nearly all major organ systems in autistic adults compared to non-autistic adults, using both binary logistic regression and network models. Healthcare professionals must be made aware of the range of co-occurring physical health conditions that may be more common among autistic people. However, our findings also point towards potential avenues requiring further exploration, such as the association of autism with both Coeliac’s disease and EDS.

Central Sensitivity Symptoms and Autistic Traits in Autistic and non-Autistic Adults

“…It is possible that these issues are also gender related, since women tend to be underdiagnosed (Begeer et al, 2013;Loomes et al, 2017) whereas CSS are more commonly recognised in women compared to men (Lawrence et al, 2008). Whilst there is a demonstrable overlap in physical symptoms between autism and CSS, the results of this study, and other recent studies (Ward et al, 2023), suggest that the CSI and AQ are both working reliably and consistently to identify symptoms of central sensitisation and autistic traits, and that there are increased rates of central sensitivity symptoms and diagnoses in autistic adults.…”

“…Joint hypermobility disorders and the Ehlers-Danlos syndromes (EDS) are often found to underly CSS diagnoses (Csecs et al, 2022;J. Eccles et al, 2020;Sharp et al, 2021), and autistic women in particular are more likely to be diagnosed with EDS than the general population (Casanova et al, 2020;Ward et al, 2023). There is also some research suggesting that sensory sensitivity is directly related to connective tissue differences (Casanova et al, 2020;Colman et al, 2023;Csecs et al, 2022;Savage et al, 2021).…”

“…Our results show that autistic people with a CSS are more prone to depression than autistic adults without a CSS, which is problematic for a community that already experiences increased rates of mental health difficulties and suicide (Cassidy & Rodgers, 2017;Hirvikoski et al, 2016;Lai, Meng-Chuan, Lombardo, Michael V, Baron-Cohen, 2013). An increasing body of research has demonstrated that autistic people are more vulnerable to a broad range of chronic illness and disease (Croen et al, 2015;Rydzewska et al, 2019;Ward et al, 2023;Weir et al, 2020;Z. J. Williams & Gotham, 2022), and that there are also significant barriers to healthcare for autistic people (Doherty et al, 2022;Nicolaidis et al, 2015;Shaw et al, 2023), but there is very little research that examines the lived experience of autistic people with cooccurring medical conditions, or considers psychosocial factors in the context of physical ill health, such as camouflaging (Pearson & Rose, 2021), illness beliefs (de Heer et al, 2017;Moss-Morris et al, 2002) and epistemic injustice (Blease et al, 2017;Chapman & Carel, 2020).…”

“…Some of the primary symptoms associated with CSS are also frequently experienced by autistic and otherwise neurodivergent people; this can include sleep problems and fatigue, sensory hypersensitivity, and cognitive processing difficulties (Sala et al, 2020). Autistic people are known to be more likely to experience chronic ill health than the general population (Croen et al, 2015;Ward et al, 2023;Weir et al, 2020) and there is some evidence to suggest that chronic pain (Lipsker et al, 2018;Whitney & Shapiro, 2019) and somatic symptoms (Z. J. Williams, 2021) might be more common in the autistic community.…”

“I’m dealing with a health care system that doesn’t get it”: Barriers and facilitators to inclusive healthcare for autistic adults

“…A growing body of research points to high rates of most major psychiatric disorders and chronic medical conditions among autistic adults, including depression, anxiety, psychoses, obsessive-compulsive disorder (OCD), bipolar disorder, and attention deficit disorder as well as hyperlipidemia, epilepsy, sleep disorders, obesity, diabetes, cardiovascular disease, and hypertension (Bishop et al, 2021; Bishop-Fitzpatrick & Rubenstein, 2019; Broder-Fingert et al, 2014; Buck et al, 2014; Croen et al, 2015; McLean et al, 2021; Tyler et al, 2011). Most recently, research has found that autistic adults may have a higher risk of cardiometabolic diseases, central sensitivity syndromes, Parkinson’s disease, gastrointestinal issues, and most other non-communicable diseases (Dhanasekara et al, 2023; Grant et al, 2022; Hand et al, 2020; Ward et al, 2023). Determining the mechanisms underlying the high prevalence of poor health outcomes in autistic adults requires better understanding of the lived experiences of autistic adults across the adult lifespan.…”