Disease and mortality trajectories of cognitively able autistic individuals in mid- and later adulthood
Abstract Background An increasing number of autistic adults have entered their later life, but little is known about the disease trajectory in mid- and later adulthood. We aimed to examine the patterns of comorbidity progression in adults with autism spectrum disorder (ASD) that may affect their mor...
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2025-05-01
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| Online Access: | https://doi.org/10.1186/s12916-025-04095-x |
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| author | Yiwei Pu Feng Li Tailin Zhu Jiong Li Wei Zhou Lingli Zhang Jingyu Chen Qianlong Zhang Tai Ren Fei Li |
| author_facet | Yiwei Pu Feng Li Tailin Zhu Jiong Li Wei Zhou Lingli Zhang Jingyu Chen Qianlong Zhang Tai Ren Fei Li |
| author_sort | Yiwei Pu |
| collection | DOAJ |
| description | Abstract Background An increasing number of autistic adults have entered their later life, but little is known about the disease trajectory in mid- and later adulthood. We aimed to examine the patterns of comorbidity progression in adults with autism spectrum disorder (ASD) that may affect their mortality. Methods Participants were identified from the UK Biobank study. We first identified individuals with ASD diagnosis, each of whom was randomly matched to up to 10 participants without ASD diagnosis. Cox regression was used to estimate the hazard ratio (HR) of mortality. Disease trajectory analysis was performed to investigate temporal sequencing of medical conditions and mortality associated with ASD. A multistate model was used to investigate the association patterns between ASD and three common chronic conditions: cardiovascular disease/hypertension, type 2 diabetes and disorders of lipoprotein metabolism, and depression/anxiety. Results The study included 659 ASD cases (66.8% male; mean age 52.0 [SD, 8.1]) and 6590 matched non-autistic individuals. ASD were associated with a 90% higher all-cause mortality (HR, 1.90, 95% CI, 1.41–2.55) and also higher risks of 45 medical conditions across almost all body systems (all Bonferroni-adjusted P < 0.05). Trajectory analyses exhibited three clusters of medical conditions that predisposed autistic adults to excess mortality: cardiometabolic diseases, external conditions, and infectious diseases. Autistic adults showed not only an overall increased risk of progression of multimorbidity but also distinctive association patterns across different disease transitions. Conclusions Our findings show patterns of comorbidities among autistic adults in their mid- and later adulthood, which could provide information to their caregivers to implement appropriate disease management and prevention strategies. |
| format | Article |
| id | doaj-art-238e1beb7bc84ee88cdd2596485d1a18 |
| institution | OA Journals |
| issn | 1741-7015 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj-art-238e1beb7bc84ee88cdd2596485d1a182025-08-20T01:51:32ZengBMCBMC Medicine1741-70152025-05-0123111110.1186/s12916-025-04095-xDisease and mortality trajectories of cognitively able autistic individuals in mid- and later adulthoodYiwei Pu0Feng Li1Tailin Zhu2Jiong Li3Wei Zhou4Lingli Zhang5Jingyu Chen6Qianlong Zhang7Tai Ren8Fei Li9Department of Developmental and Behavioural Paediatric & Child Primary Care & Ministry of Education—Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Developmental and Behavioural Paediatric & Child Primary Care & Ministry of Education—Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Developmental and Behavioural Paediatric & Child Primary Care & Ministry of Education—Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Developmental and Behavioural Paediatric & Child Primary Care & Ministry of Education—Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Developmental and Behavioural Paediatric & Child Primary Care & Ministry of Education—Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Developmental and Behavioural Paediatric & Child Primary Care & Ministry of Education—Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Developmental and Behavioural Paediatric & Child Primary Care & Ministry of Education—Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Developmental and Behavioural Paediatric & Child Primary Care & Ministry of Education—Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Developmental and Behavioural Paediatric & Child Primary Care & Ministry of Education—Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Developmental and Behavioural Paediatric & Child Primary Care & Ministry of Education—Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineAbstract Background An increasing number of autistic adults have entered their later life, but little is known about the disease trajectory in mid- and later adulthood. We aimed to examine the patterns of comorbidity progression in adults with autism spectrum disorder (ASD) that may affect their mortality. Methods Participants were identified from the UK Biobank study. We first identified individuals with ASD diagnosis, each of whom was randomly matched to up to 10 participants without ASD diagnosis. Cox regression was used to estimate the hazard ratio (HR) of mortality. Disease trajectory analysis was performed to investigate temporal sequencing of medical conditions and mortality associated with ASD. A multistate model was used to investigate the association patterns between ASD and three common chronic conditions: cardiovascular disease/hypertension, type 2 diabetes and disorders of lipoprotein metabolism, and depression/anxiety. Results The study included 659 ASD cases (66.8% male; mean age 52.0 [SD, 8.1]) and 6590 matched non-autistic individuals. ASD were associated with a 90% higher all-cause mortality (HR, 1.90, 95% CI, 1.41–2.55) and also higher risks of 45 medical conditions across almost all body systems (all Bonferroni-adjusted P < 0.05). Trajectory analyses exhibited three clusters of medical conditions that predisposed autistic adults to excess mortality: cardiometabolic diseases, external conditions, and infectious diseases. Autistic adults showed not only an overall increased risk of progression of multimorbidity but also distinctive association patterns across different disease transitions. Conclusions Our findings show patterns of comorbidities among autistic adults in their mid- and later adulthood, which could provide information to their caregivers to implement appropriate disease management and prevention strategies.https://doi.org/10.1186/s12916-025-04095-xAutistic adultDisease trajectoryMulticomorbidityCohort study |
| spellingShingle | Yiwei Pu Feng Li Tailin Zhu Jiong Li Wei Zhou Lingli Zhang Jingyu Chen Qianlong Zhang Tai Ren Fei Li Disease and mortality trajectories of cognitively able autistic individuals in mid- and later adulthood BMC Medicine Autistic adult Disease trajectory Multicomorbidity Cohort study |
| title | Disease and mortality trajectories of cognitively able autistic individuals in mid- and later adulthood |
| title_full | Disease and mortality trajectories of cognitively able autistic individuals in mid- and later adulthood |
| title_fullStr | Disease and mortality trajectories of cognitively able autistic individuals in mid- and later adulthood |
| title_full_unstemmed | Disease and mortality trajectories of cognitively able autistic individuals in mid- and later adulthood |
| title_short | Disease and mortality trajectories of cognitively able autistic individuals in mid- and later adulthood |
| title_sort | disease and mortality trajectories of cognitively able autistic individuals in mid and later adulthood |
| topic | Autistic adult Disease trajectory Multicomorbidity Cohort study |
| url | https://doi.org/10.1186/s12916-025-04095-x |
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