Brief Report: Impact of COVID-19 in Individuals with Autism Spectrum Disorders: Analysis of a National Private Claims Insurance Database.
Arun Karpur, Vijay Vasudevan, Andy Shih and 1 others
PMID 34041682WHAT IT FOUND
During early pandemic, people with autism had lower recorded COVID-19 rates than many other groups, but if infected they were much more likely to be hospitalized and stay longer, especially when autism co-occurred with intellectual or developmental disability.
Key findings
01After adjusting for age group and gender, individuals with ASD + ID were more than nine times likely to be hospitalized (OR = 9.3; 95% CI: 6.9-12.5), ASD + DD were nearly six times more likely (OR = 5.9; 95% CI: 4.7-7.3), and ASD only were almost four times more likely (OR = 3.6; 95% CI: 2.9-4.6).
02After adjustment, individuals with ASD + ID were six times more likely to have elevated length of hospital stay (OR = 5.9; 95% CI: 3.5-10.1), ASD + DD four times more likely (OR = 4.0; 95% CI: 2.7-5.9), and ASD only nearly three times more likely (OR = 2.8; 95% CI: 1.8-4.5).
03The estimated prevalence of COVID-19 infection was 2.01% among individuals with ASD + ID, 0.75% among individuals with ASD + DD, and 0.90% among individuals with ASD only, while overall prevalence was 2.04%.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This is a retrospective claims analysis, not a treatment trial, so it cannot show that autism caused higher hospitalization or longer stays. The data are from private insurance claims only, while many people with ASD have Medicaid, so the sample may not represent the broader ASD population. The data only cover February 1, 2020 through September 30, 2020, and the authors note prevalence may have been higher later. ASD and other conditions were identified by diagnostic codes, which may miss people, and hospitalization was partly inferred from timing around codes. The regression models were exploratory stepwise models, and the analysis was not designed to test a therapy outcome. Race and ethnicity were often missing in the private claims data, so disparities could not be examined. The lower prevalence in ASD groups may reflect younger age and living with family, not lower biological risk. The study reports hospitalization and length of stay, not functional, communication, or therapy outcomes.
The easy way to misread this
Do not read the lower prevalence as protection or the higher hospitalization odds as proof that autism caused worse COVID-19 outcomes. The study is observational, uses private claims data, and the authors note coding, insurance, and event-attribution limits.