The Association of Autism Diagnosis With Socioeconomic Status

4 Aug

The CDC’ autism prevalence estimates are probably the most quoted values. Not too long ago, the estimate was 1 in 166. Then 1 in 150. About a year ago, the estimate was revised to 1 in 100.

But, these numbers are estimates. And, more importantly, these estimates spam a wide range. Autism prevalence estimates vary by state and by ethnicity.

The state with the highest prevalence estimate is New Jersey. A team in New Jersey has analyzed the most recent data for the relationship on factors such as race/ethnicity and household income.

What did they find? Kids from high income families are twice as likely to get an autism designation as kids from less affluent areas.

The prevalence estimate in wealthy areas? 17 per 1000. Or 1 in 59.

Here is the abstract:

Background: In 2007 the Centers for Disease Control and Prevention (CDC) reported a higher prevalence of autism spectrum disorder (ASD) in New Jersey, one of the wealthiest states in the United States, than in other surveillance regions. Objective: To examine the association of socioeconomic status (SES) with ASD prevalence. Methods: Information on eight-year-olds with ASD from four counties was abstracted from school and medical records. US Census 2000 provided population and median household income data. Results: 586 children with ASD were identified: autism prevalence was 10.2/1000, higher in boys than girls (16 vs. 4/1000); higher in white and Asian non-Hispanics than in black non-Hispanics and Hispanics (12.5, 14.0, 9.0, and 8.5/1000, respectively); and higher (17.2/1000 (95% CI 14.0-21.1)) in tracts with median income >US$90,000 than in tracts with median income ?US$30,000 (7.1 (95% CI 5.7-8.9)). Number of professional evaluations was higher, and age at diagnosis younger, in higher income tracts (p < .001), but both measures spanned a wide overlapping range in all SES levels. In multivariable models race/ethnicity did not predict ASD, but the prevalence ratio was 2.2 (95% CI 1.5-3.1) when comparing highest with lowest income tracts. Conclusions: In the US state of New Jersey, ASD prevalence is higher in wealthier census tracts, perhaps due to differential access to pediatric and developmental services.

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5 Responses to “The Association of Autism Diagnosis With Socioeconomic Status”

  1. Visitor August 4, 2011 at 16:57 #

    I find this post (as with many others in the autism advocacy field) difficult on grounds that you describe “autistic spectrum disorder” as “autism”.

    The authors of this paper do not. I would find it very interesting indeed if higher socioeconomic groups had double the diagnoses of DSMIV autism, whereas double the diagnosis of ASD doesn’t seem to me all that surprising.

    Is there some reason why the research community’s dogged persistence with “ASD” is wrong and ought to be set aside?

    • Sullivan August 12, 2011 at 22:00 #

      Visitor,

      It was a bit sloppy to mix “autism” and “ASD”, I admit. It is a problem when trying to discuss the rise in “autism” rates over time, certainly.

      However it seems to this reader that with DSMV, the question of “autism” and “autism spectrum disorders” will go away. In my mind I don’t see the value in carrying “autism”, “PDD-NOS” and “Asperger Syndrome” as separate entities if they are going away as distinct diagnoses anyway.

      So, yes. My bad. Not too worried about it now, and will be even less flustered by it in a year or two.

  2. vmgillen August 4, 2011 at 18:00 #

    Eight-year olds are school children – it is appropriate to look at this in terms of education systems. More often than not children from distressed socio-economic strata are classified as Emotionally Disturbed behaviour problems… These populations do not “self refer” – referrals come from teachers who are unable to ‘handle’ certain students, and ultimately the process operates to the benefit of the education system, rather than the student, with placement in a segregated (holding tank) class with minimal support – maybe 1/2 hour of “counselling” per week. Higher on the socio-economic ladder it is more often parents seeking referral, and seeking specific outcomes for their children – and a Dx of ASD is given despite the same presenting conditions. (see NYC Advocates for Children v. NYC Board of Education, eg)

  3. Laurentius Rex August 12, 2011 at 14:47 #

    @Visitor to suggest that there is a uniform and coherent “research community” is about as inaccurate as to suggest there is uniform and coherent “advocacy community”

    The research community are as varied, individual and opinionated as anyone else and not everybody favours ASD at all, the D has fallen much out of favour in the Uk, and DSMIV or any of it’s precedents and successors have little to do with research or uniformity at all, it is an insurance code and not much more. Studying the DSM is more relevant to sociology than science as it is clear to most people that there are socio economic factors that drive access to any medical diagnosis and shifts in the pattern of diagnoses not only in mental health but physical impairment too.

  4. livsparents August 13, 2011 at 00:36 #

    What kind of conclusions can we draw from this? I’ve heard some in the past relate it to higher vaccination rates, but that reminds me of that old joke:

    (insert politically incorrect ethnic group) Scientist is studying frogs He puts the frog on the table and says “Jump frog, jump!”. Frog jumps 4 feet. Scientist writes “Frog with both legs jumps 4 feet.”
    He chops off one of the frog’s legs, he puts the frog back on the table and says “Jump frog, jump!”. Frog jumps 2 feet. Scientist writes “Frog with one leg jumps 2 feet.”

    He chops off the other frog leg, puts the frog back on the table and says “Jump frog, jump!”. Frog does not move. Scientist writes: “Frog with no legs goes deaf.”

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