Assessment of racial and ethnic bias in autism spectrum disorder prevalence estimates from a US surveillance system.
Pamela Imm, Tiffany White, Maureen S Durkin
PMID 30892923WHAT IT FOUND
Reported autism prevalence gaps between white and black or Hispanic children were not explained by missing residency or race data.
Black and Hispanic children were more often left as suspected cases when only school records were available.
Key findings
01Compared with 1,886 confirmed ASD cases, the 27 likely cases excluded for unconfirmed residency were significantly more likely to be Hispanic (44% vs 19%, p <.002); none of the 27 and 9% of the confirmed cases were black.
02In 2014, children were classified as suspected ASD cases at different rates by record source: 58% with education records only, 27% with health records only, and 19% with both; black and Hispanic children were more likely to have education-only records (45% and 23%) than white children (11%).
03After adding selected suspected cases to confirmed cases, prevalence estimates rose to 13.3 per 1,000 for Hispanic, 15.7 for black, and 16.9 for white children; the white-to-black prevalence ratio became 1.1 and was no longer significantly elevated, while the white-to-Hispanic ratio remained 1.3.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study used only two surveillance sites, Colorado and Wisconsin, so it may not reflect other states. It relied on existing health and education records, so children without documented developmental concerns or special education needs were not captured. The researchers had to assume what would have happened if missing residency, race/ethnicity, or suspected case status had been recorded, including adding a random 35% of some suspected cases. It did not have immigration status data, so it could not tell whether residency confirmation problems were especially common among immigrant families. The findings are about how children were counted in surveillance, not about treatment effects or whether a child truly has autism.
Declared interests
The supplied article text does not include a conflict-of-interest declaration. The publication types list NIH and U.S. government research support.
The easy way to misread this
Do not conclude that autism is truly less common in black or Hispanic children. The study found differences in record availability and case classification, not a causal difference in autism occurrence.