A Comparison of the Epidemiological Factors and Burden of Autism Spectrum Disorders Worldwide and in China

Purpose: The goal of this study is to compare the trends and variations in the burden of autism globally and in China by year, age, gender, region, and the correlations with socioeconomic, environmental, and behavioral factors, using disability-adjusted life years. Methods: The prevalence and DALYs of ASD from 1990 to 2019 were used in our analysis of the burden of ASD. Global and national epidemiological data were gathered from the Global Burden of Disease 2019 study database. Using linear regression, the correlations between the age-standardized DALYs rate and socioeconomic, environmental, and behavioral factors were assessed. Results: The DALYs numbers due to ASD increased by 39% globally and 14% in China respectively from 1990 to 2019. The global ASD peak age for both males and females is 5 years old, with multiple peaks of increasing trends observed in China for both genders at the ages of 5,30, and 50 years. Males have 3-4 times the DALYs, incidence, and prevalence as females. In 2019, China had the highest DALYs numbers, while the United Kingdom had the highest age-standardized DALYs rate. The impact of ASD on health varied substantially across countries. The age-standardized DALYs were strongly related to socioeconomic factors (GDP per capita, R²=0.305; HDI, R²=0.287; Health expenditure (% of GDP), R²=0.088; p<0.05). The age-standardized DALYs rate related to ASD was positively correlated with per capita alcohol intake, adversely correlated with PM2.5, and insignificantly correlated with tobacco use prevalence. Conclusion: Over the last 30 years, the health impact of ASD has steadily risen. It caused significant health loss, particularly for preschool children in households with a drinking habit from a higher socioeconomic level country.