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. 2010 Jul 12;5(7):e11551.
doi: 10.1371/journal.pone.0011551.

Socioeconomic inequality in the prevalence of autism spectrum disorder: evidence from a U.S. cross-sectional study

Maureen S Durkin  1 , Matthew J Maenner, F John Meaney, Susan E Levy, Carolyn DiGuiseppi, Joyce S Nicholas, Russell S Kirby, Jennifer A Pinto-Martin, Laura A Schieve
Affiliations

Socioeconomic inequality in the prevalence of autism spectrum disorder: evidence from a U.S. cross-sectional study

Maureen S Durkin et al. PLoS One. .

Abstract

Background: This study was designed to evaluate the hypothesis that the prevalence of autism spectrum disorder (ASD) among children in the United States is positively associated with socioeconomic status (SES).

Methods: A cross-sectional study was implemented with data from the Autism and Developmental Disabilities Monitoring Network, a multiple source surveillance system that incorporates data from educational and health care sources to determine the number of 8-year-old children with ASD among defined populations. For the years 2002 and 2004, there were 3,680 children with ASD among a population of 557,689 8-year-old children. Area-level census SES indicators were used to compute ASD prevalence by SES tertiles of the population.

Results: Prevalence increased with increasing SES in a dose-response manner, with prevalence ratios relative to medium SES of 0.70 (95% confidence interval [CI] 0.64, 0.76) for low SES, and of 1.25 (95% CI 1.16, 1.35) for high SES, (P<0.001). Significant SES gradients were observed for children with and without a pre-existing ASD diagnosis, and in analyses stratified by gender, race/ethnicity, and surveillance data source. The SES gradient was significantly stronger in children with a pre-existing diagnosis than in those meeting criteria for ASD but with no previous record of an ASD diagnosis (p<0.001), and was not present in children with co-occurring ASD and intellectual disability.

Conclusions: The stronger SES gradient in ASD prevalence in children with versus without a pre-existing ASD diagnosis points to potential ascertainment or diagnostic bias and to the possibility of SES disparity in access to services for children with autism. Further research is needed to confirm and understand the sources of this disparity so that policy implications can be drawn. Consideration should also be given to the possibility that there may be causal mechanisms or confounding factors associated with both high SES and vulnerability to ASD.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Prevalence per 10001 of ASD by three SES indicators based on census block group of residence.
1Thin bars indicate 95% confidence intervals. Within each SES indicator, both the trend test and χ2 tests were significant at p<0.0001. 2MHI refers to median household income.
See this image and copyright information in PMC

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