Differences in Co-Morbidity and Health Services Utilization Between Children with and without Autism Spectrum Disorder.

Background:

Children with Autism Spectrum Disorder (ASD) tend to suffer from comorbid clinical conditions. We aimed to study the comorbidity burden and health utilization of children with ASD, in order to highlight potential etiologies and better understand the needs of children with ASD provided by caregivers.

Methods:

This case-control study included all children born at Soroka University Medical Center (SUMC) between 2009-2016 diagnosed with ASD. Controls (without ASD) were matched by age, sex, and ethnicity, in a 1:5 ratio. Comorbid diagnoses were classified via pathophysiological etiology and anatomical/systemic classification of disease. We assessed the adjusted odds ratio of ASD associated with comorbidities and health utilization via multivariate logistic regression models.

Results:

ASD children have higher rates of pathophysiological (p<0.001) and anatomical/systemic (p<0.001) comorbidities. Allergy/hypersensitivity, congenital conditions, hearing impairment, and overweight were associated with increased risk of ASD; OR(95CI)=1.371(1.018–1.846), 1.857(1.325–2.603), 3.762(1.720–8.231), 1.468(1.003–2.147), respectively, and with a trend towards gastrointestinal disease; OR(95CI)=1.601(0.987-2.958), as well as auricular, cardiovascular, dermatological and ophthalmological disease; OR(95CI)=3.733(1.234-11.287), 1.634(1.023-2.608), 2.508(1.112-5.656), and 3.121(1.474-6.607), respectively. ASD children have a higher chance of visiting their physician and being admitted when referred to the ED; OR(95CI)=1.498(1.194-1.881), 1.479(1.184-1.846), respectively. They have no risk for a prolonged admission ≥48hours; OR(95CI)=1.201(0.879-1.641) nor for admission to the pediatric intensive care unit (PICU); OR(95CI)=1.045(0.492-2.219).

Discussion:

Our results accentuate conclusions drawn by previous studies showing children with ASD have a risk of auditory, cardiac, and gastrointestinal diseases and a risk of hypersensitive disorders. This strengthens hypotheses regarding possible shared etiologies and pathology that results in the impairments of Autism, such as the immunological, cardiovascular and gastrointestinal systems. We believe the excessive utilization of health services is primarily due to this burden of comorbidity. More research can shed light on this condition and help caregivers better understand and meet the medical needs of these children.