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Increased rates of chronic physical health conditions across all organ systems in autistic adolescents and adults.

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BACKGROUND: The poorer physical health of autistic adults compared to non-autistic adults has been highlighted by several epidemiological studies. However, research has so far been limited to specific geographical areas and has primarily focused on young autistic individuals (aged 35 years and younger). Recent studies indicate a higher rate of mortality in autistic people, as well as poorer quality of self-reported healthcare interactions. This study aims to determine, first, whether autistic people experience greater levels of non-communicable health conditions and second, whether these are explained by differences in demographics (i.e. sex, country of residence, ethnicity, education level), alcohol use, smoking, body mass index (BMI), or family history of medical conditions. METHOD: We employed a cross-sectional, convenience-sampling study via an anonymous, online survey of autistic and non-autistic adults (n = 2305, mean age = 41.6, 65.9% female, 49% autistic). The survey asked participants to self-report information about their demographics, autism diagnosis, diet, exercise, sleep, sexual health, substance use, personal medical history, and family medical history (for all first-degree, biological relatives). Binomial logistic regression across four iterative models of increasing complexity was applied to assess rates of physical health conditions. The Benjamini-Hochberg correction was used to account for multiple testing, and only physical health conditions that achieved at least 1% endorsement within the overall sample (n > 22) were included in the analysis to reduce risk of Type I errors. We also used novel network analysis methods to test whether there are increased levels of multimorbidity between autistic and non-autistic people. RESULTS: There were significantly elevated rates of non-communicable conditions across all organ systems in autistic people, including gastrointestinal, neurological, endocrine, visual, ear/nose/throat, skin, liver and kidney, and haematological conditions. We confirmed previous findings by showing highly significant differences in rates of neurological and gastrointestinal symptoms (p < 0.0001). In addition, we established in the largest sample to date that Ehler-Danlos Syndrome (EDS) was more likely to occur among autistic females compared to non-autistic females. Finally, we found a higher prevalence of Coeliac's disease among autistic individuals compared to non-autistic individuals after controlling for sex, ethnicity, country of residence, alcohol use, smoking, and BMI, but these results became non-significant after accounting for family history. LIMITATIONS: Our study is biased towards females, white individuals, highly educated people, and UK residents, likely due to sampling biases. Our self-report study design may also exclude those who lack access to computers, or those with intellectual disability. Our network analysis is also limited in size. CONCLUSIONS: This study provides evidence of widespread, physical health comorbidity that spans nearly all major organ systems in autistic adults compared to non-autistic adults, using both binary logistic regression and network models. Healthcare professionals must be made aware of the range of co-occurring physical health conditions that may be more common among autistic people. However, our findings also point towards potential avenues requiring further exploration, such as the association of autism with both Coeliac's disease and EDS.


Acknowledgements: We are grateful to Dr Mike Lombardo and Dr Richard Bethlehem for their input regarding network analysis. We are also grateful to our participants and those who distributed our survey, without whom this research would not be possible.

Funder: Queen Anne's Gate Foundation

Funder: Corbin Charitable Trust

Funder: Templeton World Charity Foundation; doi:

Funder: NIHR Applied Research Collaboration East of England

Funder: SFARI


Autism, Chronic illness, Ehlers-Danlos syndrome, Gastrointestinal condition, Neurological condition, Physical health, Rheumatological condition, Humans, Adolescent, Adult, Female, Male, Autistic Disorder, Cross-Sectional Studies, Body Mass Index, Educational Status, Exercise

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Mol Autism

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Wellcome Trust (102199/Z/13/Z)
Wellcome Trust (214322/Z/18/Z)
National Institute for Health and Care Research (IS-BRC-1215-20014)
Funding for this project was generously provided by the Autism Research Trust (Grant No.: RG72423), the Rosetrees Trust (Grant No.: G102199), and Cambridgeshire and Peterborough NHS Foundation Trust (Grant No.: G102307). EW also received funding from the Queen Anne’s Gate Foundation, the Autism Centre of Excellence at Cambridge (ACE), the Cambridge and Peterborough NHS Foundation Trust, and the Corbin Charitable Trust. SBC received funding from the Wellcome Trust 214322\Z\18\Z. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The results leading to this publication have received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777394 for the project AIMS-2-TRIALS. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. SBC also received funding from the Autism Centre of Excellence, SFARI, the Templeton World Charitable Fund and the MRC.All research at the Department of Psychiatry in the University of Cambridge is supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014) and NIHR Applied Research Collaboration East of England. Any views expressed are those of the author(s) and not necessarily those of the funders, IHU-JU2, the NIHR or the Department of Health and Social Care.