Friday, 27 November 2015

Premature mortality and autism continued

"Premature mortality was markedly increased in ASD [autism spectrum disorder] owing to a multitude of medical conditions."

So said the study by Tatja Hirvikoski and colleagues [1] and findings that although making uncomfortable reading, highlight how we have some way to go when it comes to addressing important health inequalities as and when a label of autism or ASD is given.

Drawing on Swedish data including over 27,000 people diagnosed with an ASD between 1987 and 2009 compared against population information for some 2.6 million "gender-, age- and county of residence-matched controls", researchers examined the frequency of all-cause and cause-specific mortality rates across the groups. During their observation period some 0.9% of controls died compared with 2.6% of those on the autism spectrum. As per the opening sentence, this difference was described as "markedly increased" by the authors. Other important details are also provided as per the idea that gender and "general intellectual ability" might be moderating factors when it comes to the mortality patterns described with autism in mind.

Realising that behind every statistic is a person and a family and a wider social group, I was not surprised by the Hirvikoski findings. Increased rates of early mortality when discussed in the context of autism have been talked about before on this blog (see here). In that previous case it was the findings reported by Deborah Bilder and colleagues [2] as the headline paper and their results based on data from the 1980s Utah/UCLA autism epidemiologic study. Then, as this time, "the presence of comorbid medical conditions and intellectual disability" played their part.

There is an obvious need for continued need for research in this important area. Preferential screening is also perhaps implied based on the known over-representation of conditions like epilepsy or seizures disorder(s) when it comes to autism (see here) and onwards the potential for states such as SUDEP. Indeed, recognising that a diagnosis of autism may place someone at elevated risk of various medical comorbidity (see here) really needs to be talked about a lot more as per what seems to be happening when it comes to schizophrenia (see here) in the context of health inequalities leading to early mortality.

Just before I go, I'd also like to refer you back to a post I wrote previously talking about 'issues' with screening and diagnosing certain medical comorbidity (see here) with autism in mind and how attending physicians might need to show a little medical creativity to ensure that diagnosis is both timely and accurate...


[1] Hirvikoski T. et al. Premature mortality in autism spectrum disorder. Br J Psychiatry. 2015 Nov 5.

[2] Bilder D. et al. Excess mortality and causes of death in autism spectrum disorders: a follow up of the 1980s Utah/UCLA autism epidemiologic study. J Autism Dev Disord. 2013 May;43(5):1196-204.

---------- Hirvikoski T, Mittendorfer-Rutz E, Boman M, Larsson H, Lichtenstein P, & Bölte S (2015). Premature mortality in autism spectrum disorder. The British journal of psychiatry : the journal of mental science PMID: 26541693