Ethnicity, where a patient lives and socioeconomic factors may impact the likelihood of receiving an autism diagnosis, according to a new study, revealing inequalities in how the condition is diagnosed.
The research, led by the University of Cambridge, shows clusters of autism diagnoses, which can be linked to socioeconomic factors, ethnicity, and specific NHS or local authority regions.
It found ‘clear inequalities’ in autism diagnosis, with black people and other minority ethnic groups more likely to be diagnosed as autistic. The findings are published in The Lancet Child & Adolescent Health.
Autism is characterised by lifelong difficulties in social communication and interaction combined with unusually restricted, repetitive behavioural patterns, interests, or activities. The prevalence of autism in the English school system is 1·8%.
The researchers examined data from the Summer School Census, which collects information from children aged one to eighteen in state-funded schools in England. Between 2014 and 2017, they found more than 102,000 new autism cases in the 32 million pupils studied, representing a rate of 1 in 234 children with a new diagnosis during the four-year period.
New cases were clustered within specific NHS service regions, suggesting that where an individual lives may influence whether they receive a diagnosis and what access they have to special educational needs support.
The highest proportion of hotspots of diagnosis, places with the highest numbers of new cases, were found in the South East of England, closely followed by the West Midlands and the East Midlands.
Hotspot clusters among clinical commissioning groups were found in NHS Rotherham, where 46% of the catchment area had higher-than-average new autism diagnoses clusters, and NHS Heywood, Middleton and Rochdale and NHS Liverpool, with 39% and 37% of the catchment area had higher-than-average new autism diagnoses clusters respectively, suggesting a possible health service effect on diagnosis probability.
The results also show that socially disadvantaged pupils had increased odds of autism, as did pupils from ethnically diverse and deprived areas, compared with pupils from ethnically homogenous and less deprived areas.
Dr Andres Roman-Urrestarazu from the University of Cambridge said: ‘Autism diagnoses are more common among black students and other minority ethnic groups. Why this is the case is not clear, and so we need to explore the role played by social factors such as ethnicity and area deprivation as well as the nature of local services.’
The researchers suggest that the findings emphasise the need to pay more attention to disadvantaged minority groups and to distinguish whether the ethnic differences in diagnosis are a product of environmental or health system factors.
Dr Robin van Kessel, co-lead researcher from the London School of Economics and Political Science, said: ‘These new findings show how social determinants interact and can combine to significantly increase the likelihood of an autism diagnosis. As a result, individuals from a minority ethnic background experiencing economic hardship may be significantly more likely to receive an autism diagnosis than their peers.’
