Neighborhood Disadvantages Do Not Influence Minority Children’s High Autism Spectrum Diagnoses

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Children of mothers from minority groups in a population with health insurance are associated with having a higher likelihood of receiving an autism spectrum diagnosis (ASD). Yet only children of White mothers had ASD diagnoses associated with neighborhood disadvantages.¹

“The mechanisms behind these patterns are unknown and merit future research,” the investigators wrote. “However, they may be due to systemic racism, discrimination, and their impact on maternal health during pregnancy.”

ASD affects 2.3% of U.S. children, and family-level socioeconomic status has been associated with the disorder. Previous research suggests in the U.S., after 2010, lower family-level socioeconomic status was associated to higher ASD diagnosis. Moreover, in May 2023, the Centers for Disease Control and Prevention (CDC) shared Black and Hispanic children are diagnosed more frequently with autism than White children in the U.S. Approximately 3% of Black, Hispanic, Asian, or Pacific Islander children receive an autism diagnosis, while only about 2% of White children do.²

Though, little is known about neighborhood disadvantages. A new study, led by Xin Yu, MS, of spatial science institute at University of Southern California in Los Angeles, sought to examine the association between ASD and neighborhood disadvantages.¹

The cohort study examined a retrospective birth cohort from the integrated health care system, Kaiser Permanente Southern California. The cohort included children born in 2001 to 2014, and the investigators analyzed the data from February 2022 to September 2023. The sample included 5164 males and 1193 females. Out of the 318,372 mothers during the study period, 6357 children had ASD diagnoses during the follow-up with a median age of 3.53 years old. Children were followed up from age 1 year until either the first ASD diagnosis, the last date of Kaiser Permanente Southern California membership, death, or December 31, 2019.

The team specifically looked at birth year, child sex, maternal age at delivery, parity, and severe pre-pregnancy health conditions for hazard ratios. They defined neighborhoods as what the U.S. census listed as a participant’s residential address at birth. Data came from the 200 U.S. decennial census for births from 2001 to 2001 and from the American Survey 5-year estimates from births 2005-2014. Neighborhood disadvantage indicators included poverty, unemployment, female-headed households with children, public assistance, less than a high school education, bachelor’s degree or greater, and professional occupation.

Neighborhood disadvantage was linked with a higher likelihood of ASD diagnosis (hazard ratio [HR], 1.07; 95% CI, 1.02 – 1.11). Also, children of mothers from minority racial and ethnic groups (such as African American, Asian, Pacific Islander, or Hispanic/Latinx groups) had a higher likelihood of ASD diagnoses than children with White mothers. The investigators found no significant association of maternal education and ASD diagnosis (P = .07) or child sex (P = .10). Though, males were 4.3 times more likely than females to have ASD diagnoses.

Despite children of minority groups having a higher likelihood of ASD diagnoses, neighborhood disadvantage was only associated with ASD for children of White mothers (hazard ratio [HR], 1.17; 95% CI, 1.09-1.26).

“It is possible that families from minoritized racial and ethnic groups may not experience similar health improvements with increasing neighborhood SES as White populations because of the discrimination and related stressors and barriers experienced in more affluent neighborhood,” the investigators concluded.

References

1. ^{Yu X, Rahman MM, Carter SA, et al. Neighborhood Disadvantage and Autism Spectrum Disorder in a Population With Health Insurance [published online ahead of print, 2023 Nov 15]. JAMA Psychiatry. 2023;10.1001/jamapsychiatry.2023.4347. doi:10.1001/jamapsychiatry.2023.4347}
2. ^{Higher Autism Prevalence and COVID-19 Disruptions. Centers for Disease Control and Prevention. May 8, 2023. https://www.cdc.gov/ncbddd/autism/features/new-autism-spectrum-disorder-report.html#:~:text=ASD%20was%20identified%20at%20higher,old%20White%20children%20(2.4%25). Accessed November 15, 2023.}