Association of race/ethnicity and social disadvantage with autism prevalence in 7 million school children in England.
Open accessAbstract
Importance: The global prevalence of autism spectrum disorder (ASD) has been reported to be between 1% and 2% of the population, with little research in Black, Asian, and other racial/ethnic minority groups. Accurate estimates of ASD prevalence are vital to planning diagnostic, educational, health, and social care services and may detect possible access barriers to diagnostic pathways and services and inequalities based on social determinants of health. Objective: To evaluate whether socioeconomic disadvantage is associated with ASD prevalence and the likelihood of accessing ASD services in racial/ethnic minority and disadvantaged groups in England. Design, Setting, and Participants: This case-control prevalence cohort study used the Spring School Census 2017 from the Pupil Level Annual Schools Census of the National Pupil Database, which is a total population sample that includes all English children, adolescents, and young adults aged 2 to 21 years in state-funded education. Data were collected on January 17, 2017, and analyzed from August 2, 2018, to January 28, 2020. Exposures: Age and sex were treated as a priori confounders while assessing correlates of ASD status according to (1) race/ethnicity, (2) social disadvantage, (3) first language spoken, (4) Education, Health and Care Plan or ASD Special Educational Needs and Disability support status, and (5) mediation analysis to assess how social disadvantage and language might affect ASD status. Main Outcomes and Measures: Sex- and age-standardized ASD prevalence by race/ethnicity and 326 English local authority districts in pupils aged 5 to 19 years. Results: The final population sample consisted of 7 047 238 pupils (50.99% male; mean [SD] age, 10.18 [3.47] years) and included 119 821 pupils with ASD, of whom 21 660 also had learning difficulties (18.08%). The standardized prevalence of ASD was 1.76% (95% CI, 1.75%-1.77%), with male pupils showing a prevalence of 2.81% (95% CI, 2.79%-2.83%) and female pupils a prevalence of 0.65% (95% CI, 0.64%-0.66%), for a male-to-female ratio (MFR) of 4.32:1. Standardized prevalence was highest in Black pupils (2.11% [95% CI, 2.06%-2.16%]; MFR, 4.68:1) and lowest in Roma/Irish Travelers (0.85% [95% CI, 0.67%-1.03%]; MFR, 2.84:1). Pupils with ASD were more likely to face social disadvantage (adjusted prevalence ratio, 1.61; 95% CI, 1.59-1.63) and to speak English as an additional language (adjusted prevalence ratio, 0.64; 95% CI, 0.63-0.65). The effect of race/ethnicity on ASD status was mediated mostly through social disadvantage, with Black pupils having the largest effect (standardized mediation coefficient, 0.018; P < .001) and 12.41% of indirect effects through this way. Conclusions and Relevance: These findings suggest that significant differences in ASD prevalence exist across racial/ethnic groups and geographic areas and local authority districts, indicating possible differential phenotypic prevalence or differences in detection or referral for racial/ethnic minority groups.
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Some persons with ADHD/ASD are often from socioeconomically disadvantaged groups/areas and are more likely to be exposed to environmental risk factors (eg, substance misuse, violence) than other populations.
“However, some persons with ADHD/ASD are often from socioeconomically disadvantaged groups/areas and are more likely to be exposed to environmental risk factors (eg, substance misuse, violence) than other populations.61,62,63”
From Mortality in Persons With Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis (2022) · cites this paper as [61]
In 2018, the inverse association of higher ASD identification in the group with lower MHI was observed among children aged 4 years in the ADDM Network.
“In 2018, the inverse association of higher ASD identification in the group with lower MIH was observed among children aged 4 years in the ADDM Network, consistent with reports using recent California Department of Developmental Services data (20) and England Spring School Census data (21).”
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“EXPOSURES Age and sex were treated as a priori confounders while assessing correlates of ASD status according to (1) race/ethnicity, (2) social disadvantage, (3) first language spoken, (4) Education, Health and Care Plan or ASD Special Educational Needs and Disability support status, and (5) mediation analysis to asse…”
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Self-citation
- Authors
- Roman-Urrestarazu, A., van Kessel, R., Allison, C., Matthews, F. E., Brayne, C., & Baron-Cohen, S.
- Affiliations
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of International Health, School CAPHRI (School for Public Health and Primary Care), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- University of Cambridge (GB)
- Newcastle University (GB)
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2021-06-07
- Volume
- 175
- Issue
- 6
- Pages
- e210054
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- PMC
- PMC8008434
- OpenAlex
- W3148807712
- Cited by
- 242
- References
- 38
- Citations by year
- 2026: 33 · 2025: 41 · 2024: 58 · 2023: 48 · 2022: 46 · 2021: 15
- FWCI
- 21.96
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- Repository@Hull (Worktribe) (University of Hull) (submittedVersion, cc-by)
- Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, cc-by)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Apollo (cc-by)
- Funders
- Autism Speaks (777394)
- Simons Foundation
- Wellcome Trust (214322, 777394, 214322/Z/18/Z)
- European Federation of Pharmaceutical Industries and Associations (777394)
- Simons Foundation Autism Research Initiative
- National Institute for Health and Care Research (NF-SI-0616-10090)
- Department of Health and Social Care
- European Commission (HORIZON2020, 777394)
- Medical Research Council (777394)
- NIHR Cambridge Biomedical Research Centre
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- autism spectrum disorder, autism prevalence, racial and ethnic minorities, social deprivation, socioeconomic disparities, special educational needs and disabilities, Education, Health and Care plans, mother tongue, learning difficulties, sex ratio, social determinants of health, elementary school students, England, local authority districts, mediation analysis, National Pupil Database
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Child, Child, Preschool, England, Female, Humans, Infant, Male, Poverty, Registries, Prevalence, Case-Control Studies, Young Adult, Social Determinants of Health
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