The association of autism diagnosis with socioeconomic status

Department of Preventive Medicine and Community Health, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, USA.
Autism (Impact Factor: 3.5). 08/2011; 16(2):201-13. DOI: 10.1177/1362361311413397
Source: PubMed


In 2007 the Centers for Disease Control and Prevention (CDC) reported a higher prevalence of autism spectrum disorder (ASD) in New Jersey, one of the wealthiest states in the United States, than in other surveillance regions.
To examine the association of socioeconomic status (SES) with ASD prevalence.
Information on eight-year-olds with ASD from four counties was abstracted from school and medical records. US Census 2000 provided population and median household income data.
586 children with ASD were identified: autism prevalence was 10.2/1000, higher in boys than girls (16 vs. 4/1000); higher in white and Asian non-Hispanics than in black non-Hispanics and Hispanics (12.5, 14.0, 9.0, and 8.5/1000, respectively); and higher (17.2/1000 (95% CI 14.0-21.1)) in tracts with median income >US$90,000 than in tracts with median income ≤US$30,000 (7.1 (95% CI 5.7-8.9)). Number of professional evaluations was higher, and age at diagnosis younger, in higher income tracts (p < .001), but both measures spanned a wide overlapping range in all SES levels. In multivariable models race/ethnicity did not predict ASD, but the prevalence ratio was 2.2 (95% CI 1.5-3.1) when comparing highest with lowest income tracts.
In the US state of New Jersey, ASD prevalence is higher in wealthier census tracts, perhaps due to differential access to pediatric and developmental services.

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    • "Thought to be the result of a complex interaction between genetics and environmental factors, the etiology of ASD remains unknown and no single biological marker exists . Consequently, diagnosis is based on observed behavioral characteristics and parent report and, as with any behaviorally defined disorder, the point at which normal variation becomes deviant and how such deviation is interpreted is strongly influenced by cultural context (Norbury and Sparks 2013), including demographic factors such as race/ethnicity, family income, and parental education level (Dyches et al. 2004; Mandell et al. 2002; Mazurek et al. 2014; Ravindran and Myers 2012; Thomas et al. 2012). Within the United States, an individual may receive a clinical diagnosis of ASD in a medical setting and/or an educational classification of Autism (AU) in a public school setting. "
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    ABSTRACT: Autism spectrum disorder (ASD) diagnoses are made based on a pattern of behavioral symptoms, yet a growing body of research indicates that when, and indeed whether, an individual receives a diagnosis of ASD is influenced by myriad demographic factors including race, ethnicity, socioeconomic status (SES), and parental education level. The current manuscript provides a focused review of a subset of existing literature chosen to demonstrate how demographic factors may be related to the identification of individuals with ASD within the United States. Several possible explanations for existing disparities are discussed, along with clinical implications for professionals working with children from diverse backgrounds who are suspected of having ASD. Additional research in this area is needed to facilitate development of effective means to eliminate the diagnostic disparities.
    Full-text · Article · Jul 2015
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    • "Two studies citing institutional barriers were adjusted for family income and found African American families remained more dissatisfied with the quality of their child's health care than Caucasian families of children with ASD (Liptak et al. 2008; Sansosti et al. 2012). Studies that examined socioeconomic status (SES) and ASD diagnosis reported African American children from low income families were consistently associated with delayed diagnoses , but when controlled for SES African American children with ASD were less likely to have adequate access to health care across incomes (Bhasin and Schendel 2007; Fountain et al. 2011; Jarquin et al. 2011; Liptak et al. 2008; Magana et al. 2012; Mandell et al. 2010a, b; Rosenberg et al. 2011; Thomas et al. 2012; Valicenti-McDermott et al. 2012). "
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    ABSTRACT: Cultural factors such as health care access and autism spectrum disorder (ASD) symptom interpretations have been proposed as impacting delayed diagnosis and treatment for African American children with ASD. A qualitative study of urban African American families caring for their child with autism was conducted with 24 family members and 28 ASD professionals. Cultural caring meant families protected their child from harm including potential or actual distrustful encounters, and took action for their child and community to optimize their child's health and address the knowledge deficits of ASD within their community. Families and professionals believed cultural influences delayed families' receiving and seeking appropriate health care for the African American child with ASD affecting timely autism diagnosis and treatment.
    Full-text · Article · Jun 2015 · Journal of Autism and Developmental Disorders
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    ABSTRACT: The present study aims to characterize the prevalence of autism spectrum disorders (ASDs) in Taiwan while examining the effects of age, gender, and urbanization on ASD occurrence. A cross-sectional study was conducted to analyze data from 895,639 random health insurance claimants who claimed medical services in the year 2007. Autism was defined using the ICD-9-CM Diagnosis Code 299.0 (autism, current or active). The prevalence of autistic cases was found to be 12.3‰ (10,868/884,771) in the general population, with the prevalence among males (19.2‰) significantly higher than that among females (6‰). With regards to age distribution, we found that the autistic group (mean age=16.0years) was significantly younger than the general population (mean age=37.2years). A logistic regression analysis found that age, gender, residence urbanization level and Bureau of National Health Insurance regional division all constituted influence factors for autistic occurrence. The results demonstrate the importance of taking into account age, gender, and geographical disparities in autistic prevalence in order to implement appropriate public health policies for the ASD population.
    No preview · Article · Apr 2012 · Research in Autism Spectrum Disorders
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