Premature mortality in autism due to medical conditions
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Premature mortality in autism, early deaths due to medical conditions
While autism is currently diagnosed on the basis of the presence of abnormalities in social communication and repetitive behaviours, many common medical conditions are significantly more prevalent in both children and adults with autism compared to the general population. Individuals with autism die on average much younger than control population and have a substantially higher prevalence of many serious medical conditions. The severity of these conditions most often correlates with the severity of autism.
Results of a recent study which used large nationwide Swedish population-based register confirmed that the diseases of nervous, circulatory, respiratory and digestive systems are very prevalent and are the common causes of early deaths of individuals with autism.
Premature mortality is significantly increased in autism–estimated to be three to ten times higher than the general population, with the average life expectancy of a person with severe autism being only 39.5 years. While mortality is higher across variety of medical conditions, the single most common cause of premature death in severe autism is epilepsy.
“Recognition of seizure disorders in adults with ASD is particularly important due to its association with worse overall health status, decreased functional ability, and overall mortality.”
In contrast, the average life expectancy in individuals with high-functioning autism/Asperger syndrome was revealed by this study to be 58 years. While this is much higher than the life expectancy in severe autism, it is still considerably lower than life expectancy in the general population. Although all autism-severity groups have significantly elevated mortality compared with the general population controls across all medical conditions, in the high-functioning subgroup of individuals with autism there is also a significantly increased risk of death by suicide.
“We found that increased mortality in ASD was not limited to certain causes of death, such as diseases of nervous system, but was elevated for all analysed categories… our results add to the accumulating evidence indicating that ASD accounts for substantial health loss across the lifespan”
Another smaller study by Fortuna and colleagues compared health outcomes in parallel to independence with daily living activities across the age groups in autism. Compared to the general population, young adults aged 18–29 with autism had a substantially higher prevalence of seizure disorder (11.2% vs. 1.4%), depression (16.4% vs. 6.4%), hypertension (12.9 % vs. 6.3 %), and allergies (39.7 % vs. 8.4 %). Prevalence of many medical conditions – including seizure disorders – was increased in the older age groups of adults, while the independence with daily living activities decreased with age.
“In participants over 40 years old, only 54.2 % were independent with eating, 43.0 % were independent with dressing, and 43.1 % were independent with bathing. In this age group, 4.2 % required a cane or walker and 10.7 % required a wheelchair.”
Factors that were associated with lower health status were: female gender, seizure disorder, gastroesophageal reflux disease, attention deficit hyperactivity disorder, and dental disease.
Fortuna RJ, Robinson L, Smith TH, et al. (2016) Health Conditions and Functional Status in Adults with Autism: A Cross-Sectional Evaluation. J Gen Intern Med. Jan;31(1):77-84. doi: 10.1007/s11606-015-3509-x.
Hirvikoski T, Mittendorfer-Rutz E, Boman M, et al. (2016) Premature mortality in autism spectrum disorder. Br J Psychiatry. Mar;208(3):232-8. doi: 10.1192/bjp.bp.114.160192.
Schendel DE, Overgaard M, Christensen J, et al. (2016) Association of Psychiatric and Neurologic Comorbidity With Mortality Among Persons With Autism Spectrum Disorder in a Danish Population. JAMA Pediatr. Mar;170(3):243-50. doi: 10.1001/jamapediatrics.2015.3935.