Adults with autism from underrepresented populations at higher risk for diabetes, high BP

Adults with autism spectrum disorder from underrepresented populations were more likely than white adults with ASD to have cooccurring conditions such as diabetes and hypertension, according to a recent analysis of Medicaid data.

“Racial and ethnic differences in physical health conditions have been documented in studies of the general population and may be attributed to socioeconomic circumstances, discrimination in the health services environment, and/or genetic differences,” Whitney Schott, MA, PhD, an assistant research professor at the A.J. Drexel Autism Institute at Drexel University in Philadelphia, and colleagues wrote in Autism Research. “The present analysis seeks to fill a gap in the literature examining racial and ethnic disparities in cooccurring conditions among the autistic adult Medicaid population in the United States.”

The researchers reviewed data from 166,952 adult Medicaid beneficiaries with ASD and 466,851 adult Medicaid beneficiaries without ASD. The dataset included adults from each of the 50 United States. The majority of the individuals in both cohorts were white men.

Compared with white adults with ASD, the researchers found that adults with ASD who were Black had higher odds of diabetes (adjusted OR [aOR] = 1.7), hypertension (aOR = 1.9), obesity (aOR = 1.47), hospitalization for CVD (aOR = 1.29), asthma (aOR = 1.24) and nutrition conditions (aOR = 1.22).

Meanwhile, adults with ASD who were Hispanic had higher odds of diabetes (aOR = 1.65), obesity (aOR = 1.77), hepatic disease (aOR = 1.64), nutrition conditions (aOR = 1.53), genetic disorders (aOR = 1.51), hypertension (aOR = 1.39), low vision and blindness (aOR = 1.38), asthma (aOR = 1.33), autoimmune disease (aOR = 1.29), CVD (aOR = 1.26) and headaches (aOR = 1.22) compared with adults with ASD who were white.

Adults with ASD who were Asian or Pacific Islander also had higher odds of diabetes (aOR = 1.71) and hypertension (aOR = 1.23), as well as higher odds of gout (aOR = 3.3), Downs syndrome (aOR = 1.5) and dyslipidemia (aOR = 1.27) compared with those who were white, according to the researchers.

The data also showed that, overall, adults with ASD had a higher prevalence of nutrition conditions (aOR = 1.38; 99% CI, 1.36-1.41), vitamin deficiency (aOR = 1.13; 99% CI, 1.1-1.16), epilepsy and recurrent seizures (aOR = 1.39; 1.36-1.42) and Parkinson’s and related diseases (aOR = 1.54; 99% CI, 1.37-1.72) than those who did not have ASD.

“The prevalence of many of these conditions among the autistic adults in our sample was higher than in some previous research,” the researchers wrote.

While smaller studies had a lower prevalence of certain conditions among ASD populations, Schott and colleagues noted that their findings align with a larger study conducted in 2015 of adults with ASD who had private insurance. In that study, the prevalence of CVD was 40%, diabetes was 7.6%, hypertension was 25.6%, epilepsy was 11.9% and cancer was 1.7%. These conditions were, respectively, present in 40%, 8.6%, 14.3%, 18.4% and 4.5% of adults with ASD in Schott and colleagues’ study.

“Differences in health condition prevalence among autistic adults in public versus private health insurance are to be expected, as Medicaid likely serves a more vulnerable population,” Schott and colleagues wrote. “Therefore, it is notable that we found similar prevalence of several conditions.”

Schott and colleagues also noted that interventions within state Medicaid programs, including managed care, “more generous” waivers for home- and community-based services and Medicaid expansion, “have shown potential” to lower racial and ethnic disparities among patients with ASD. However, “additional approaches tailored to state Medicaid programs, with access via eligibility criteria/processes and service delivery, are likely needed to further reduce disparities,” they wrote.