Your browser doesn't support javascript.
loading
Neighborhood Disadvantage and Autism Spectrum Disorder in a Population With Health Insurance.
Yu, Xin; Rahman, Md Mostafijur; Carter, Sarah A; Lin, Jane C; Chow, Ting; Lurmann, Frederick W; Chen, Jiu-Chiuan; Martinez, Mayra P; Schwartz, Joel; Eckel, Sandrah P; Chen, Zhanghua; McConnell, Rob; Xiang, Anny H; Hackman, Daniel A.
Affiliation
  • Yu X; Spatial Science Institute, University of Southern California, Los Angeles.
  • Rahman MM; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles.
  • Carter SA; Department of Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
  • Lin JC; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena.
  • Chow T; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena.
  • Lurmann FW; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena.
  • Chen JC; Sonoma Technology, Petaluma, California.
  • Martinez MP; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles.
  • Schwartz J; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena.
  • Eckel SP; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Chen Z; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • McConnell R; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles.
  • Xiang AH; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles.
  • Hackman DA; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles.
JAMA Psychiatry ; 81(2): 209-213, 2024 Feb 01.
Article in En | MEDLINE | ID: mdl-37966844
ABSTRACT
Importance Family socioeconomic status has been associated with autism spectrum disorder (ASD) diagnoses. Less is known regarding the role of neighborhood disadvantage in the United States, particularly when children have similar access to health insurance.

Objective:

To evaluate the association between neighborhood disadvantage and the diagnosis of ASD and potential effect modification by maternal and child demographic characteristics. Design, Setting, and

Participants:

This cohort study examined a retrospective birth cohort from Kaiser Permanente Southern California (KPSC), an integrated health care system. Children born in 2001 to 2014 at KPSC were followed up through KPSC membership records. Electronic medical records were used to obtain an ASD diagnosis up to December 31, 2019, or the last follow-up. Data were analyzed from February 2022 to September 2023. Exposure Socioeconomic disadvantage at the neighborhood level, an index derived from 7 US census tract characteristics using principal component analysis. Main Outcomes and

Measures:

Clinical ASD diagnosis based on electronic medical records. Associations between neighborhood disadvantage and ASD diagnosis were determined by hazard ratios (HRs) from Cox regression models adjusted for birth year, child sex, maternal age at delivery, parity, severe prepregnancy health conditions, maternal race and ethnicity, and maternal education. Effect modification by maternal race and ethnicity, maternal education, and child sex was assessed.

Results:

Among 318 372 mothers with singleton deliveries during the study period, 6357 children had ASD diagnoses during follow-up; their median age at diagnosis was 3.53 years (IQR, 2.57-5.34 years). Neighborhood disadvantage was associated with a higher likelihood of ASD diagnosis (HR, 1.07; 95% CI, 1.02-1.11, per IQR = 2.70 increase). Children of mothers from minoritized racial and ethnic groups (African American or Black, Asian or Pacific Islander, Hispanic or Latinx groups) had increased likelihood of ASD diagnosis compared with children of White mothers. There was an interaction between maternal race and ethnicity and neighborhood disadvantage (difference in log-likelihood = 21.88; P < .001 for interaction under χ24); neighborhood disadvantage was only associated with ASD among children of White mothers (HR, 1.17; 95% CI, 1.09-1.26, per IQR = 2.00 increase). Maternal education and child sex did not significantly modify the neighborhood-ASD association. Conclusions and Relevance In this study, children residing in more disadvantaged neighborhoods at birth had higher likelihood of ASD diagnosis among a population with health insurance. Future research is warranted to investigate the mechanisms behind the neighborhood-related disparities in ASD diagnosis, alongside efforts to provide resources for early intervention and family support in communities with a higher likelihood of ASD.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Autism Spectrum Disorder Limits: Adult / Child / Child, preschool / Female / Humans / Newborn / Pregnancy Country/Region as subject: America do norte Language: En Journal: JAMA Psychiatry Year: 2024 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Autism Spectrum Disorder Limits: Adult / Child / Child, preschool / Female / Humans / Newborn / Pregnancy Country/Region as subject: America do norte Language: En Journal: JAMA Psychiatry Year: 2024 Document type: Article
...