Autism Spectrum Disorders in China: An Analysis of Temporal Trends in Prevalence, Incidence, and DALYs (1990-2021) Based on GBD 2021 Data.

Abstract

Objectives: To examine the temporal trends in the prevalence, incidence, and disability-adjusted life years (DALYs) of autism spectrum disorder (ASD) in China from 1990 to 2021 and to project the future burden to 2036.

Methods: Data were sourced from the Global Burden of Disease (GBD) 2021 provided by the Institute for Health Metrics and Evaluation (IHME). Join-point regression was applied to estimate the annual percentage change (APC) of prevalence, incidence, and DALYs. Age-period-cohort analysis was used to assess the effects of age, period, and cohort. Decomposition analysis quantified the contributions of population growth, demographic aging, and epidemiological changes. An AutoRegressive Integrated Moving Average (ARIMA) model was employed for projections to 2036.

Results: Between 1990 and 2021, the average annual percentage change (AAPC) was 0.22% (95% uncertainty interval [UI]: 0.20%-0.24%) for prevalence, -0.07% (95% UI: -0.14%-0.28%) for incidence, and 0.23% (95% UI: 0.21%-0.25%) for DALYs. ASD prevalence and DALYs peaked in children aged 0-5 years and declined after age 60. Rising prevalence and DALYs were mainly attributable to population growth (89.7% and 95.2%) and epidemiological changes (32.6% and 36.2%), while aging offset growth (-22.4% and -16.0%). Projections indicated stable age-standardized incidence for both sexes but divergent prevalence trends, with rates increasing among males and decreasing among females.

Conclusions: The ASD burden in China is rising, largely driven by demographic and epidemiological dynamics, with young children and males being the most affected groups. Prioritizing early detection and gender-sensitive interventions are recommended.