The Co-Morbidity Burden of Children and Young Adults with Autism Spectrum Disorders

Objectives Use electronic health records Autism Spectrum Disorder (ASD) to assess the comorbidity burden of ASD in children and young adults. Study Design A retrospective prevalence study was performed using a distributed query system across three general hospitals and one pediatric hospital. Over 14,000 individuals under age 35 with ASD were characterized by their co-morbidities and conversely, the prevalence of ASD within these comorbidities was measured. The comorbidity prevalence of the younger (Age<18 years) and older (Age 18–34 years) individuals with ASD was compared. Results 19.44% of ASD patients had epilepsy as compared to 2.19% in the overall hospital population (95% confidence interval for difference in percentages 13.58–14.69%), 2.43% of ASD with schizophrenia vs. 0.24% in the hospital population (95% CI 1.89–2.39%), inflammatory bowel disease (IBD) 0.83% vs. 0.54% (95% CI 0.13–0.43%), bowel disorders (without IBD) 11.74% vs. 4.5% (95% CI 5.72–6.68%), CNS/cranial anomalies 12.45% vs. 1.19% (95% CI 9.41–10.38%), diabetes mellitus type I (DM1) 0.79% vs. 0.34% (95% CI 0.3–0.6%), muscular dystrophy 0.47% vs 0.05% (95% CI 0.26–0.49%), sleep disorders 1.12% vs. 0.14% (95% CI 0.79–1.14%). Autoimmune disorders (excluding DM1 and IBD) were not significantly different at 0.67% vs. 0.68% (95% CI −0.14-0.13%). Three of the studied comorbidities increased significantly when comparing ages 0–17 vs 18–34 with p<0.001: Schizophrenia (1.43% vs. 8.76%), diabetes mellitus type I (0.67% vs. 2.08%), IBD (0.68% vs. 1.99%) whereas sleeping disorders, bowel disorders (without IBD) and epilepsy did not change significantly. Conclusions The comorbidities of ASD encompass disease states that are significantly overrepresented in ASD with respect to even the patient populations of tertiary health centers. This burden of comorbidities goes well beyond those routinely managed in developmental medicine centers and requires broad multidisciplinary management that payors and providers will have to plan for.

[1]  M. Taylor,et al.  The prevalence of schizophrenia: a reassessment using modern diagnostic criteria. , 1978, The American journal of psychiatry.

[2]  Richard D. Smith,et al.  Abnormal Head Circumference in Learning‐disabled Children , 1981, Developmental Medicine & Child Neurology.

[3]  R. Lawrence,et al.  A comparison of patients with spondyloarthropathy seen in specialty clinics with those identified in a communitywide epidemiologic study. Has the classic case misled us? , 1997, Archives of internal medicine.

[4]  J. Papadimitriou,et al.  Gastrointestinal abnormalities in children with autistic disorder. , 1999, The Journal of pediatrics.

[5]  Svend Erik Mouridsen,et al.  Epilepsy in disintegrative psychosis and infantile autism: a long‐term validation study , 1999, Developmental medicine and child neurology.

[6]  L. Forsén,et al.  Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trøndelag Health Survey , 1999, Diabetologia.

[7]  T. Isager,et al.  The natural history of somatic morbidity in disintegrative psychosis and infantile autism: a validation study , 1999, Brain and Development.

[8]  S. E. Mouridsen,et al.  Psychiatric Morbidity in Disintegrative Psychosis and Infantile Autism:A Long-Term Follow-Up Study , 1999, Psychopathology.

[9]  Karoly Horvath,et al.  Autistic disorder and gastrointestinal disease , 2002, Current opinion in pediatrics.

[10]  R. Tuchman,et al.  Epilepsy in autism , 2002, The Lancet Neurology.

[11]  J. Marc Overhage,et al.  Analysis of identifier performance using a deterministic linkage algorithm , 2002, AMIA.

[12]  C. Black,et al.  Relation of childhood gastrointestinal disorders to autism: nested case-control study using data from the UK General Practice Research Database , 2002, BMJ : British Medical Journal.

[13]  J. Marc Overhage,et al.  Analysis of a Probabilistic Record Linkage Technique without Human Review , 2003, AMIA.

[14]  M. Roy,et al.  Psychiatric comorbidity and medication use in autism: a community survey , 2003 .

[15]  Underreporting of Computed Tomography and Magnetic Resonance Imaging Procedures in Inpatient Claims Data , 2005, Medical care.

[16]  K. Kuban,et al.  Association of Duchenne Muscular Dystrophy With Autism Spectrum Disorder , 2005, Journal of child neurology.

[17]  Isaac S. Kohane,et al.  Integration of Clinical and Genetic Data in the i2b2 Architecture , 2006, AMIA.

[18]  Peter Szolovits,et al.  Evaluating the state-of-the-art in automatic de-identification. , 2007, Journal of the American Medical Informatics Association : JAMIA.

[19]  Walter C Willett,et al.  Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. , 2007, American journal of epidemiology.

[20]  Lori C. Phillips,et al.  Using the i2b2 hive for clinical discovery: an example. , 2007, AMIA ... Annual Symposium proceedings. AMIA Symposium.

[21]  J. Vles,et al.  Neuropsychiatric Disorders in Males With Duchenne Muscular Dystrophy: Frequency Rate of Attention-Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder, and Obsessive—Compulsive Disorder , 2008, Journal of child neurology.

[22]  S. Waisbren,et al.  Cognitive and Psychological Profile of Males With Becker Muscular Dystrophy , 2008, Journal of child neurology.

[23]  Yuan Luo,et al.  Identifying patient smoking status from medical discharge records. , 2008, Journal of the American Medical Informatics Association : JAMIA.

[24]  D. Geschwind,et al.  Advances in autism genetics: on the threshold of a new neurobiology , 2008, Nature Reviews Genetics.

[25]  M. Brimacombe,et al.  Autism Spectrum Disorders: Concurrent Clinical Disorders , 2008, Journal of child neurology.

[26]  Douglas MacFadden,et al.  Application of Information Technology The Shared Health Research Information Network ( SHRINE ) : A Prototype Federated Query Tool for Clinical Data Repositories , 2014 .

[27]  A. Mack.  Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcus: Comparison of Diagnosis and Treatment in the Community and at a Specialty Clinic , 2009 .

[28]  Sowmya R. Rao,et al.  Use of electronic health records in U.S. hospitals. , 2009, The New England journal of medicine.

[29]  I. Kohane,et al.  Instrumenting the health care enterprise for discovery research in the genomic era. , 2009, Genome research.

[30]  M. Sordo,et al.  Rapid Identification of Myocardial Infarction Risk Associated With Diabetes Medications Using Electronic Medical Records , 2009, Diabetes Care.

[31]  K. Davis,et al.  Using Medicare payment policy to transform the health system: a framework for improving performance. , 2009, Health affairs.

[32]  A. Richdale,et al.  Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies. , 2009, Sleep medicine reviews.

[33]  P. Kaufmann,et al.  Association of autistic spectrum disorders with dystrophinopathies. , 2009, Pediatric neurology.

[34]  The Actual Prevalence of Autism: Are We There Yet? , 2010, Pediatrics.

[35]  J. Buizer-Voskamp,et al.  Systematic genotype–phenotype analysis of autism susceptibility loci implicates additional symptoms to co-occur with autism , 2010, European Journal of Human Genetics.

[36]  P. Levitt,et al.  Genetic disruption of the autism spectrum disorder risk gene PLAUR induces GABAA receptor subunit changes , 2010, Neuroscience.

[37]  Urvashi Surti,et al.  Deletion 17q12 is a recurrent copy number variant that confers high risk of autism and schizophrenia. , 2010, American journal of human genetics.

[38]  D. Coury,et al.  Medical treatment of autism spectrum disorders , 2010, Current opinion in neurology.

[39]  Griffin M. Weber,et al.  Serving the enterprise and beyond with informatics for integrating biology and the bedside (i2b2) , 2010, J. Am. Medical Informatics Assoc..

[40]  I. Kohane,et al.  Electronic medical records for discovery research in rheumatoid arthritis , 2010, Arthritis care & research.

[41]  S. Schneeweiss,et al.  Risk of osteoporotic fracture in a large population-based cohort of patients with rheumatoid arthritis , 2010, Arthritis research & therapy.

[42]  M. Karafa,et al.  Chronic disease risks in young adults with autism spectrum disorder: forewarned is forearmed. , 2011, American journal on intellectual and developmental disabilities.

[43]  Pall I. Olason,et al.  Copy number variations of chromosome 16p13.1 region associated with schizophrenia , 2011, Molecular Psychiatry.

[44]  M. Bauman,et al.  Medical comorbidities in autism: Challenges to diagnosis and treatment , 2010, Neurotherapeutics.

[45]  N. LeLeiko,et al.  Patterns of Medical and Developmental Comorbidities Among Children Presenting With Feeding Problems: A Latent Class Analysis , 2011, Journal of developmental and behavioral pediatrics : JDBP.

[46]  H. Meltzer,et al.  Epidemiology of autism spectrum disorders in adults in the community in England. , 2011, Archives of general psychiatry.

[47]  L. Charlot,et al.  Non-psychiatric health problems among psychiatric inpatients with intellectual disabilities. , 2011, Journal of intellectual disability research : JIDR.

[48]  M. Maltenfort,et al.  Comparison of ICD-9-based, retrospective, and prospective assessments of perioperative complications: assessment of accuracy in reporting. , 2011, Journal of neurosurgery. Spine.