Male and Female Healthcare Trajectories in Autism: Are There Any Differences Considering Age at Diagnosis and Intellectual or Developmental Disabilities Status?

Abstract

The aim of this study was to compare the healthcare trajectories (HCTs) 2 years after a first diagnosis of autism according to sex, age at diagnosis, and intellectual or developmental disabilities (IDD) status. This is a retrospective cohort study using health administrative data from Québec, Canada. The cohort included all individuals with a first diagnosis of autism registered by a physician between April 2012 and March 2015. HCTs were stratified by sex, presence of IDD, and age at diagnosis (youth, adult), and analyzed using state sequence analysis across healthcare settings, providers, and reasons for use. Our cohort included 5289 individuals, 76.6% were male, and 26.3% were adults at the time of diagnosis. The healthcare use decreased slightly over time, though intensity was higher in females. Sex differences in HCTs were strongly influenced by IDD status and age at diagnosis. While no significant sex differences were observed in HCTs for individuals with IDD diagnosed with autism in adulthood, the psychiatric condition profiles showed notable differences between males and females. Hospital days nearly doubled for females diagnosed in childhood compared to males, while males with IDD diagnosed with autism in childhood and males without IDD diagnosed in adulthood had fewer physical illness visits. Although physical and mental health challenges appear largely managed in ambulatory care during youth, high hospitalization rates in those diagnosed in adulthood, particularly females and those with IDD, highlight concerns about continuity of care and avoidable hospitalizations for these subgroups of patients.