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O'Nions E, Lewer D, Petersen I, Brown J, Buckman JE, Charlton R, Cooper C, El Baou CÉ, Happé F, Manthorpe J, McKechnie DG, Richards M, Saunders R, Zanker C, Mandy W, Stott J. Estimating life expectancy and years of life lost for autistic people in the UK: a matched cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 36:100776. [PMID: 38188276 PMCID: PMC10769892 DOI: 10.1016/j.lanepe.2023.100776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 01/09/2024]
Abstract
Background Previous research has shown that people who have been diagnosed autistic are more likely to die prematurely than the general population. However, statistics on premature mortality in autistic people have often been misinterpreted. In this study we aimed to estimate the life expectancy and years of life lost experienced by autistic people living in the UK. Methods We studied people in the IQVIA Medical Research Database with an autism diagnosis between January 1, 1989 and January 16, 2019. For each participant diagnosed autistic, we included ten comparison participants without an autism diagnosis, matched by age, sex, and primary care practice. We calculated age- and sex-standardised mortality ratios comparing people diagnosed autistic to the reference group. We used Poisson regression to estimate age-specific mortality rates, and life tables to estimate life expectancy at age 18 and years of life lost. We analysed the data separately by sex, and for people with and without a record of intellectual disability. We discuss the findings in the light of the prevalence of recorded diagnosis of autism in primary care compared to community estimates. Findings From a cohort of nearly 10 million people, we identified 17,130 participants diagnosed autistic without an intellectual disability (matched with 171,300 comparison participants), and 6450 participants diagnosed autistic with an intellectual disability (matched with 64,500 comparison participants). The apparent estimates indicated that people diagnosed with autism but not intellectual disability had 1.71 (95% CI: 1.39-2.11) times the mortality rate of people without these diagnoses. People diagnosed with autism and intellectual disability had 2.83 (95% CI: 2.33-3.43) times the mortality rate of people without these diagnoses. Likewise, the apparent reduction in life expectancy for people diagnosed with autism but not intellectual disability was 6.14 years (95% CI: 2.84-9.07) for men and 6.45 years (95% CI: 1.37-11.58 years) for women. The apparent reduction in life expectancy for people diagnosed with autism and intellectual disability was 7.28 years (95% CI: 3.78-10.27) for men and 14.59 years (95% CI: 9.45-19.02 years) for women. However, these findings are likely to be subject to exposure misclassification biases: very few autistic adults and older-adults have been diagnosed, meaning that we could only study a fraction of the total autistic population. Those who have been diagnosed may well be those with greater support needs and more co-occurring health conditions than autistic people on average. Interpretation The findings indicate that there is a group of autistic people who experience premature mortality, which is of significant concern. There is an urgent need for investigation into the reasons behind this. However, our estimates suggest that the widely reported statistic that autistic people live 16-years less on average is likely incorrect. Nine out of 10 autistic people may have been undiagnosed across the time-period studied. Hence, the results of our study do not generalise to all autistic people. Diagnosed autistic adults, and particularly older adults, are likely those with greater-than-average support needs. Therefore, we may have over-estimated the reduction in life expectancy experienced by autistic people on average. The larger reduction in life expectancy for women diagnosed with autism and intellectual disability vs. men may in part reflect disproportionate underdiagnosis of autism and/or intellectual disability in women. Funding Dunhill Medical Trust, Medical Research Council, National Institute for Health and Care Research, and the Royal College of Psychiatrists.
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Affiliation(s)
- Elizabeth O'Nions
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Dan Lewer
- Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Irene Petersen
- UCL Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Jude Brown
- National Autistic Society, 393 City Rd, London, EC1V 1NG, UK
| | - Joshua E.J. Buckman
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
- iCope – Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE, UK
| | - Rebecca Charlton
- Department of Psychology, Goldsmiths University of London, New Cross, London, SE14 6NW, UK
| | - Claudia Cooper
- Queen Mary University of London, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, London, E1 2AD, UK
| | - CÉline El Baou
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Memory Lane, London, SE5 8AF, UK
| | - Jill Manthorpe
- NIHR Health & Social Care Workforce Research Unit, King's College London, Strand, London, WC2R 2LS, UK
| | - Douglas G.J. McKechnie
- UCL Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Rob Saunders
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | | | - Will Mandy
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Joshua Stott
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
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Wang W, Wang X. Non-suicidal self-injury in Chinese college students with elevated autistic traits: Associations with anxiety, rumination and experiential avoidance. Compr Psychiatry 2023; 126:152407. [PMID: 37566951 DOI: 10.1016/j.comppsych.2023.152407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Although existing studies have proved that autistic traits (AT) may have relations to non-suicidal self-injury (NSSI) behaviors, its associations with anxiety, rumination and experiential avoidance (EA) are still unclear. The current study, based on a sample of 1317 Chinese college students, explored the associations between AT, anxiety and NSSI, and the possible modulating roles of rumination and EA in these associations. The results shows that 1) a total of 334 (25.36%) students reported a history of NSSI and 30 (2.28%) students were categorized as high AT; 2) Students with high AT reported higher rates of NSSI than those with low AT (36.67% vs. 25.10%); 3) AT, anxiety, rumination and EA have positive relations with NSSI; 4) AT predicted NSSI indirectly through anxiety; 5) Rumination and EA significantly moderated the effects of AT on NSSI via anxiety. In conclusion, this study confirms the indirect effect of AT on NSSI through anxiety in Chinese college students, and further clarifies the reinforcing effects of rumination and EA on the associations between AT, anxiety and NSSI. These findings suggest that developing adaptive emotion-regulating strategies and positive coping styles might promote the prevention and treatment of NSSI behaviors among autistic individuals.
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Affiliation(s)
- Wan Wang
- Department of Child Developmental Behavior, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfu Front Street, Zhengzhou 450001, China.
| | - Xi Wang
- College of Computer Science and Electronic Engineering, Hunan University, 109 Shijiachong Road, Changsha 410012, China
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Liu S, Larsson H, Kuja-Halkola R, Lichtenstein P, Butwicka A, Taylor MJ. Age-related physical health of older autistic adults in Sweden: a longitudinal, retrospective, population-based cohort study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e307-e315. [PMID: 37295448 DOI: 10.1016/s2666-7568(23)00067-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Research of health outcomes in older autistic adults (≥45 years) is concerningly scarce, and little is known about whether intellectual disability and sex affect the health outcomes of this population. The aim of this study was to investigate the association between autism and physical health conditions in older adults and to examine these associations by intellectual disability and sex. METHODS We conducted a longitudinal, retrospective, population-based cohort study of the Swedish population born between Jan 1, 1932, and Dec 31, 1967, using linked data from the nationwide Total Population Register and the National Patient Register. We excluded individuals who died or emigrated before the age of 45 years, or with any chromosomal abnormalities. Follow-up started at age 45 years for all individuals, and ended at emigration, death, or Dec 31, 2013 (the latest date of available follow-up), whichever was soonest. Diagnoses of autism, intellectual disability, 39 age-related physical conditions, and five types of injury (outcomes) were obtained from the National Patient Register. For each outcome, we calculated 25-year cumulative incidence and used Cox models to estimate hazard ratios (HRs). All analyses were repeated separately by intellectual disability and sex. FINDINGS Of 4 200 887 older adults (2 063 718 women [49·1%] and 2 137 169 men [50·9%]) in the study cohort, 5291 (0·1%) had a diagnosis of autism recorded in the National Patient Register. Older autistic adults (median follow-up 8·4 years [IQR 4·2-14·6]) had higher cumulative incidence and HRs of various physical conditions and injuries than their non-autistic counterparts (median follow-up 16·4 years [8·2-24·4]). In autistic individuals, the highest cumulative incidence was observed for bodily injuries (50·0% [95% CI 47·6-52·4]). Conditions that autistic adults were at higher risk of than were non-autistic adults included heart failure (HR 1·89 [95% CI 1·61-2·22]), cystitis (2·03 [1·66-2·49]), glucose dysregulation (2·96 [2·04-4·29]), iron deficiency anaemia (3·12 [2·65-3·68]), poisoning (4·63 [4·13-5·18]), and self-harm (7·08 [6·24-8·03]). These increased risks mainly persisted regardless of intellectual disability or sex. INTERPRETATION Our data indicate that older autistic adults are at substantially increased risk of age-related physical conditions and injuries compared with non-autistic adults. These findings highlight the need for collaborative efforts from researchers, health services, and policy makers to provide older autistic individuals with the necessary support to attain healthy longevity and a high quality of life. FUNDING Swedish Research Council, Servier Affaires Medicales. TRANSLATION For the Swedish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Stockholm, Sweden; Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland; Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Mark J Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
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Pelton MK, Crawford H, Bul K, Robertson AE, Adams J, de Beurs D, Rodgers J, Baron‐Cohen S, Cassidy S. The role of anxiety and depression in suicidal thoughts for autistic and non-autistic people: A theory-driven network analysis. Suicide Life Threat Behav 2023; 53:426-442. [PMID: 36974940 PMCID: PMC10947106 DOI: 10.1111/sltb.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Autistic adults experience more frequent suicidal thoughts and mental health difficulties than non-autistic adults, but research has yet to explain how these experiences are connected. This study explored how anxiety and depression contribute to suicidal thoughts according to the Interpersonal Theory of Suicide for autistic and non-autistic adults. METHODS Participants (autistic adults n = 463, 61% female; non-autistic n = 342, 64% female) completed online measures of anxiety, depression, thwarted belonging, and perceived burdensomeness. Network analysis explored whether: (i) being autistic is a risk marker for suicide; and (ii) pathways to suicidal thoughts are consistent for autistic and non-autistic adults. RESULTS Being autistic connected closely with feeling like an outsider, anxiety, and movement, which connected to suicidal thoughts through somatic experiences, low mood, and burdensomeness. Networks were largely consistent for autistic and non-autistic people, but connections from mood symptoms to somatic and thwarted belonging experiences were absent for autistic adults. CONCLUSION Autistic people experience more life stressors than non-autistic people leading to reduced coping, low mood, and suicidal thoughts. Promoting belonging, reducing anxiety, and understanding the role of movement could inform suicide prevention for autistic people. Research should accurately capture autistic lived experience when modeling suicide to ensure suicide prevention meets autistic needs.
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Affiliation(s)
- Mirabel K. Pelton
- Institute for Health and Wellbeing, Centre for Intelligent HealthcareCoventry UniversityCoventryUK
| | - Hayley Crawford
- Mental Health and Wellbeing Unit, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Kim Bul
- Institute for Health and Wellbeing, Centre for Intelligent HealthcareCoventry UniversityCoventryUK
| | - Ashley E. Robertson
- School of Psychology & NeuroscienceUniversity of Glasgow, University AvenueGlasgowUK
| | - Jon Adams
- Autistic Advocate and ResearcherPortsmouthUK
| | | | - Jacqui Rodgers
- Population Health Sciences InstituteSir James Spence Institute, Newcastle University, Royal Victoria InfirmaryNewcastleUK
| | - Simon Baron‐Cohen
- Autism Research Centre, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Sarah Cassidy
- School of PsychologyUniversity of Nottingham, University ParkNottinghamUK
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