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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (2): 375-383. doi: 10.19723/j.issn.1671-167X.2023.02.027

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Early death and causes of death of patients with autism spectrum disorders: A systematic review

Ya-nan ZHAO1,2,3,Hui-yun FAN3,4,Xiang-yu WANG3,4,Ya-nan LUO3,5,Rong ZHANG6,7,*(),Xiao-ying ZHENG1,3,7,*()   

  1. 1. School of Population Medicine and Public Health, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
    2. China Center for Health Development Studies, Peking University, Beijing 100191, China
    3. Peking University Asia Pacific Economic Cooperation Health Sciences Academy, Beijing 100871, China
    4. Institute of Population Research, Peking University, Beijing 100871, China
    5. Department of Global Health, Peking University School of Public Health, Beijing 100191, China
    6. Neuroscience Research Institute, Peking University; Department of Neurobiology, Peking University School of Basic Medical Sciences; Key Laboratory for Neuroscience of the Ministry of Education; Key Laboratory for Neuroscience of the Ministry of National Health Commission; Beijing 100191, China
    7. Autism Research Centre, Peking University Health Science Centre, Beijing 100191, China
  • Received:2022-04-03 Online:2023-04-18 Published:2023-04-12
  • Contact: Rong ZHANG,Xiao-ying ZHENG E-mail:zhangrong@bjmu.edu.cn;xzheng@pku.edu.cn

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Abstract:

To study of premature/early death of autistic patients from the perspective of life course can help families, medical institutions and policy makers better deal with the adverse effects of autism. Several studies have shown that autistic patients have a high risk of death, however, the results are still inconsistent. To assess the risk of mortality among the autistic patients, we undertook a comprehensive search of MEDLINE, Web of Science and EMBASE databases. This paper reviewed the studies on the negative disease outcomes of autism spectrum disorders, including the risk of death, causes of death and several research hotspots in this field. Strict inclusion/exclusion criteria were used. Information was extracted from selected papers, tabulated and synthesized. In the study, 15 studies were included, with a total of 216 045 individuals. The main outcome was all-cause mortality in association with autism and the secondary outcome was cause-specific mortality. The results showed that all-cause mortality was higher for the autistic patients (RR=2.32, 95%CI: 1.98-2.72, I2=87.1%, P < 0.001). Risk ratio showed a greater inequality for female than male (male: RR=2.00, 95%CI: 1.57-2.55, I2=93.2%, P < 0.001; female: RR=4.66, 95%CI: 3.30-6.58, I2=92.0%, P < 0.001). Compared with the unnatural death, the risk of natural death was higher (RR=3.44, 95%CI: 1.27-9.26, I2=80.2%, P=0.025). As autism had many comorbidities, which would bring more health risks and natural deaths possibilities. There were some structural differences in unnatural death. Accidental injury death and suicide were two kinds of causes. Lacking social skills would weaken the ability to ask for help when encountering injuries. This paper put forward some suggestions for futures. First, to well study the comorbidity can reduce the risk of death from a medical point of view. Second, the scientists and policymakers should pay attention to the social environment and provide a safer environment for the autistic patients. Third, for women and for adolescents without cognitive impairment, due to their high risk of suicide, the society should provide them with more supportive social networks and improve their life satisfaction. Fourth, it is necessary to balance the rehabilitation resources in various regions in China and provide more high-quality lifelong rehabilitation monitoring and care services.

Key words: Autism spectrum disorder, Risk of death, Mortality, Cause of death, Systematic review

CLC Number: 

  • R749.94

Table 1

Studies on mortality risk and gender specific mortality risk in patients with ASD"

Authors Year Country Participant with ASDa Deaths RRg(95% CI) RR (by gender)
Shavelle et al[7] 2001 USA 13 111 202 2.40 (NA) F: 5.5; M: 1.7
Pickett et al[36] 2006 USA 13 111 280 2.45 (2.18-2.76) F: 5.2; M: 2.3
Bilder et al[8] 2013 USA 305 29 11.59 (6.24-21.53) F: 30.14; M: 9.91
Akobirshoev et al[37] 2020 USA 34 237 462 1.51 (1.33-1.72) F: 2.75; M: 1.25
Isager et al[38] 1999 Denmark 341 12 1.90 (1.00-3.40) F: 3.61; M: 1.67
Mouridsen et al[6] 2008 Denmark 341 26 1.93 (1.26-2.82) F: 4.01; M: 1.57
Schendel et al[11] 2016 Denmark 20 492 68 2.00 (1.50-2.80) F: 3.5; M: 1.8
Gillberg et al[39] 2010 Sweden 120b 9 5.60 (2.50-10.50) F: 20.7; M: 2.3
Hirvikoski et al[34] 2016 Sweden 27 122 706 2.56 (2.38-2.76) F: 2.24; M: 2.87
Hwang et al[40] 2019 Australia 35 929 244 2.06 (1.64-2.58) NA
Jokiranta-Olkoniemi et al[41] 2021 Finland 4 695c 53 1.70 (1.20-2.60) F: 5.3; M: 1.5
Hosking et al[42] 2016 UK 1 532 15 2.22 (1.01-4.86) NA
Smith et al[43] 2021 UK 9 754d 6 1.10 (0.50-2.50) NA
Kim et al[44] 2021 South Korea 32 878e 237 2.50 (2.20-2.90) F: 4.8; M: 1.9
Yoo et al[45] 2022 South Korea 35 529f NA 2.34 (2.06-2.65) F: 4.22; M: 1.77

Figure 1

Risk of mortality in patients with ASD by group Diamond, estimated effect size; Width of diamond, the precision of the estimate (95%CI). ASD, autism spectrum disorder; RR, risk ratio; CI, confidence interval; ID, intellectual disorder."

Table 2

Studies on causes of mortality in patients with ASD"

Authors Year Country Participant with ASDa Deaths Natural cause Unnatural cause Undetermined
Sum Neurologic Sum Accidents Intentional self-harm
Mouridsen et al[6] 2008 Denmark 341 26 73.12% 19.23% 23.08% NA NA 3.80%
Schendel et al[11] 2016 Denmark 20 492 68 49.12% 12.28% 50.88% 26.32% 22.81% 0.00%
Shavelle et al[7] 2001 USA 13 111 202 54.45% 12.38% 24.26% NA NA 21.29%
Bilder et al[8] 2013 USA 305 29 89.66% 51.72% 10.34% NA NA 0.00%
Smith DaWalt et al[52] 2019 USA 406b 26 61.54% 11.54% 19.23% NA NA 19.23%
Gillberg et al[39] 2010 Sweden 120c 9 77.78% 44.44% 11.11% NA NA 11.11%
Hwang et al[40] 2019 Australia 35 929 255 45.00% 20.00% 23.00% NA NA 32.00%
Jokiranta-Olkoniemi et al[41] 2021 Finland 4 695d 53 50.90% NA 47.10% 24.50% 22.60% 2.00%
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