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Jump to Key Points Autism spectrum disorder (ASD) is associated with a significantly decreased life expectancy, new research suggested.
In a cross-sectional study using data from all 50 US states, life expectancy for Medicaid recipients with ASD was 13.8 years shorter than the US general population and 5.6 years shorter than all Medicaid recipients.
Although life expectancy did not differ significantly between women and men overall, there was a significant 16-year difference between women with ASD and those in the general population and an 11.6-year difference between men with ASD and those in the general population.
Investigators noted in a release that the overall life expectancy was about 65 years for Medicaid beneficiaries in the US with ASD, “which is the same as for the general population in Haiti or Angola. This finding is sobering.”
- Medicaid recipients with ASD: life expectancy 64.9 years vs 78.7 general US population.
- ASD associated with 13.8-year shorter lifespan vs US general population.
- Overall mortality risk higher in ASD: SMR 1.44 vs Medicaid population.
- Women with ASD had larger lifespan gap vs general population than men.
- Excess deaths mainly from influenza, malnutrition, pneumonitis, accidents, drowning, pneumonia.
“The good news is that much of the excess mortality among people with ASD is avoidable through improved social support, primary care, and home- and community-based services,” lead author Guohua Li, MD, DrPH, Columbia University Mailman School of Public Health, New York City, added in the statement.
The findings were published online on September 10 in a Research Letter in JAMA Network Open.
Significant Gaps
The investigators assessed data from the Transformed Medicaid Statistical Information System and the Children’s Health Insurance Program Statistical Information System, including mortality information, from 2000 through 2020.
During the study period, more than 2 million individuals with ASD (76.1% men) were enrolled in Medicaid and 18,268 of these people died. The majority were non-Hispanic White individuals (48.5%), followed by Hispanic (16.7%), non-Hispanic Black (14.6%), and other race/ethnicity (20.2%).
The overall life expectancy at birth was 64.9 years for Medicaid recipients with ASD vs 70.5 years for the overall Medicaid population and 78.7 years for the US general population.
Among participants with ASD, life expectancy was similar between men and women and between race and ethnicity groups.
The gap was greater, however, for women with ASD compared with female Medicaid beneficiaries overall (-8.2 years), the US female population (-16.0 years), as well as the male comparisons (-1.9 and -11.6 years, respectively).
‘Important Implications’
Although the projected lifespan for those with ASD increased in 2015-2019 compared with 2000-2004 (65.6 years vs 63.9 years), disparities remained, investigators noted.
Additionally, there was a significantly higher overall mortality risk for those with ASD compared with the Medicaid population (standardized mortality ratio, 1.44).
The greatest cause for the shortened lifespan in those with ASD was influenza, malnutrition, pneumonitis, nontransport accidents, accidental drowning, and pneumonia.
The researchers cited several study limitations, including that individuals with ASD who are enrolled in Medicaid are more likely to have a lower socioeconomic status than those not enrolled in the insurance program and that there were various residual bias concerns.
Still, “our findings have important implications for developing targeted interventions to reduce preventable excess mortality among people with ASD,” they wrote.
The study was funded by the National Institutes of Health and the CDC. Disclosure information for the study investigators is available in the original study publication.
