Disparities in Social Determinants of Health and Health Outcomes Among Autistic Individuals Without Intellectual Disability in Middle-to-Late Adulthood.

Abstract

Autism is increasingly recognized across the lifespan, yet little is known about how structural social disadvantage contributes to long-term health risks among autistic adults in middle and later adulthood. Participants were identified from the UK Biobank study, comprising 576 autistic adults with no intellectual disability and an average of 15.2 years of education, and 5,760 controls matched on age, sex, residing area, race, and educational attainment. Social determinants of health (SDH) were assessed using a composite score calculated from 12 indicators that characterized economic, health care, neighborhood, and social domains. Mediation analysis was performed to estimate the extent to which SDH disparities mediated the elevated mortality and chronic disease risks among autistic adults. The study sample was 66.4% male and had a mean age of 51.6 years (SD, 8.03). Autistic adults had worse SDH levels across almost all dimensions. These disparities mediated 39% of the elevated mortality risk. In addition, autistic adults showed increased incidence of cardiovascular disease, dementia, hypertension, type 2 diabetes, depression, and anxiety, with SDH disparities mediating 17% to 38% of these elevated risks. These findings indicate that multifaceted disadvantage plays a substantial role in the health inequities experienced by autistic adults, underscoring the need for cross-sector interventions and policy reforms.Lay AbstractAutistic adults face persistent disadvantage in social conditions that shape health outcomes. These disadvantages may partially explain why autistic adults face higher rates of chronic illnesses and earlier death. From a large cohort in the United Kingdom, we compared 576 autistic adults with 5,760 adults without autism across 12 indicators of social determinants of health (SDH), covering economic, health care, neighborhood, and social domains. Autistic adults showed disadvantage across nearly all domains. These disparities mediated 39% of excess mortality and 17% to 38% of the increased risk for chronic conditions, including cardiovascular disease, dementia, type 2 diabetes, depression, and anxiety. Economic deprivation and social isolation showed relatively larger mediating effects. This study provides evidence that structural inequities in SDH substantially contribute to the long-term health trajectories of autistic adults. Addressing these inequities will require policies and interventions that move beyond individual-level supports to tackle systemic barriers in employment, health care access, housing, and community participation.