Diagnosis of common health conditions among autistic adults in the UK: evidence from a matched cohort study

Elizabeth O'Nions; Jude Brown; Joshua E J Buckman; Rebecca Charlton; Claudia Cooper; Céline El Baou; Francesca Happé; Sarah Hoare; Dan Lewer; Jill Manthorpe; Douglas G J McKechnie; Marcus Richards; Rob Saunders; Will Mandy; Joshua Stott

doi:10.1016/j.lanepe.2024.100907

Diagnosis of common health conditions among autistic adults in the UK: evidence from a matched cohort study

Lancet Reg Health Eur. 2024 May 3:41:100907. doi: 10.1016/j.lanepe.2024.100907. eCollection 2024 Jun.

Authors

Elizabeth O'Nions^{1

2}, Jude Brown³, Joshua E J Buckman^{1

4}, Rebecca Charlton⁵, Claudia Cooper⁶, Céline El Baou¹, Francesca Happé⁷, Sarah Hoare¹, Dan Lewer^{2

8}, Jill Manthorpe⁹, Douglas G J McKechnie¹⁰, Marcus Richards¹¹, Rob Saunders¹, Will Mandy¹, Joshua Stott¹

Affiliations

¹ UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, 1 - 19 Torrington Place, London, WC1E 7HB, UK.
² Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK.
³ National Autistic Society, 391-393 City Rd, London, EC1V 1NG, UK.
⁴ iCope - Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE, UK.
⁵ Department of Psychology, Goldsmiths, University of London, New Cross, London, SE14 6NW, UK.
⁶ Queen Mary, University of London, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, London, E1 2AD, UK.
⁷ Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Memory Lane, London, SE5 8AF, UK.
⁸ Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
⁹ NIHR Policy Research Unit in Health & Social Care Workforce, King's College London, Strand, London, WC2R 2LS, UK.
¹⁰ UCL Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK.
¹¹ MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.

Abstract

Background: 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).

Methods: 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.

Findings: 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).

Interpretation: 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.

Funding: Dunhill Medical Trust, Economic and Social Research Council, National Institute of Health and Care Research.

Keywords: Autism; Intellectual disability; Mental health; Physical health; Primary care; Substance use.