■自闭症患者极可能经历过早死亡和大多数身心健康状况。根据全球疾病负担研究(焦虑,抑郁症,自我伤害,有害酒精的使用,物质使用,偏头痛,颈部或背部疼痛,和妇科条件)。
■参与者年龄在18岁或以上,并且在2000年1月1日至2019年1月16日期间在IQVIA医学研究数据库中记录了自闭症诊断。我们纳入了15675名没有智力残疾的自闭症成年人,6437名患有智力障碍的自闭症成年人,和一个按年龄匹配的比较组(1:10),性别,和初级保健实践。我们估计了根据年龄和性别调整后的粗发病率和发病率比率(IRRs)。
■没有智力障碍的自闭症成年人的发病率较高(IRR,95%CI)的自我伤害(2.07,1.79-2.40),焦虑(1.91,1.76-2.06),抑郁症(1.79,1.67-1.92),和物质使用(1.24,1.02-1.51)相对于比较参与者。有害酒精使用的发生率(1.01,0.85-1.18),偏头痛(0.99,0.84-1.17),和妇科条件(1.19,0.95-1.49)没有差异。颈部或背部疼痛发生率较低(0.88,0.82-0.95)。患有智力障碍的自闭症成年人的自我伤害发生率更高(2.08,1.69-2.56)。焦虑发生率(1.14,1.00-1.30),妇科条件(1.22,0.93-1.62),和物质使用(1.08,0.80-1.47)没有差异,抑郁症的发病率较低(0.73,0.64-0.83),有害酒精使用(0.65,0.50-0.84),偏头痛(0.55,0.42-0.74),和颈部或背部疼痛(0.49,0.44-0.55)。
■虽然我们的研究结果不能直接与以前的患病率研究进行比较,与之形成对比的是,在直接评估和/或调查自闭症患者共同发生的情况的研究中,自闭症患者中出现心理和生理健康状况的频率较高.目前的发现可能表明自闭症患者的常见病的诊断不足,特别是那些智力残疾的人。改善检测应该是减少健康不平等的临床和政策优先事项。
■登喜路医疗信托,经济及社会研究理事会,国家健康与护理研究所。
UNASSIGNED: Autistic people are disproportionately likely to experience premature mortality and most mental and physical health conditions. We measured the incidence of diagnosed conditions accounting for the most disability-adjusted life years in the UK population according to the Global Burden of Disease study (anxiety, depression, self-harm, harmful alcohol use, substance use, migraine, neck or back pain, and gynaecological conditions).
UNASSIGNED: Participants were aged 18 years or above and had an autism diagnosis recorded in the IQVIA Medical Research Database between 01/01/2000 and 16/01/2019. We included 15,675 autistic adults without intellectual disability, 6437 autistic adults with intellectual disability, and a comparison group matched (1:10) by age, sex, and primary care practice. We estimated crude incidences and incidence rate ratios (IRRs) adjusted for age and sex.
UNASSIGNED: Autistic adults without intellectual disability experienced a higher incidence (IRR, 95% CI) of self-harm (2.07, 1.79-2.40), anxiety (1.91, 1.76-2.06), depressive disorders (1.79, 1.67-1.92), and substance use (1.24, 1.02-1.51) relative to comparison participants. Incidences of harmful alcohol use (1.01, 0.85-1.18), migraine (0.99, 0.84-1.17), and gynaecological conditions (1.19, 0.95-1.49) did not differ. Neck or back pain incidence was lower (0.88, 0.82-0.95). Autistic adults with intellectual disability experienced a higher incidence of self-harm (2.08, 1.69-2.56). Incidences of anxiety (1.14, 1.00-1.30), gynaecological conditions (1.22, 0.93-1.62), and substance use (1.08, 0.80-1.47) did not differ, and lower incidences were found for depressive disorders (0.73, 0.64-0.83), harmful alcohol use (0.65, 0.50-0.84), migraine (0.55, 0.42-0.74), and neck or back pain (0.49, 0.44-0.55).
UNASSIGNED: Although our findings cannot be directly compared to previous prevalence studies, they contrast with the higher frequency of mental and physical health conditions in autistic adults reported in studies that directly assessed and/or surveyed autistic people about co-occurring conditions. The present findings may suggest under-diagnosis of common conditions in autistic people, particularly those with intellectual disability. Improved detection should be a clinical and policy priority to reduce health inequalities.
UNASSIGNED: Dunhill Medical Trust, Economic and Social Research Council, National Institute of Health and Care Research.