Co-occurring conditions and racial-ethnic disparities: Medicaid enrolled adults on the autism spectrum.
Whitney Schott, Sha Tao, Lindsay Shea
PMID 34854249WHAT IT FOUND
Medicaid-enrolled autistic adults had higher rates of most mental health conditions and several physical ones, but lower rates of others like stroke and cerebral palsy.
Significant racial-ethnic disparities existed in both physical and mental health diagnoses compared to white autistic adults.
Key findings
01Autistic adults had higher odds of most psychiatric conditions, including depression, bipolar disorder, anxiety, and ADHD, compared to non-autistic Medicaid beneficiaries.
02Autistic adults had higher odds of several physical conditions like epilepsy and Parkinson disease, but lower odds of stroke, cerebral palsy, and osteoarthritis.
03Racial-ethnic disparities were evident in the autistic population, with Black beneficiaries having higher odds of hypertension and diabetes but lower odds of anxiety and OCD compared to white beneficiaries.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study relies on administrative claims data, which are coded for billing purposes. Diagnoses were not clinically validated and may vary by provider. The Medicaid population is not representative of all autistic adults, as it primarily serves those with disabilities or low income. Data from 2008–2012 precedes the ACA Medicaid expansion and may not reflect current populations. Race and ethnicity data were based on administrative records (Social Security), which are imperfect and had missing values for 10% of the autistic sample. The study controlled for intellectual disability in matching, which may result in lower bound estimates of differences compared to non-autistic individuals without ID.
Declared interests
The research was supported by the National Institute of Mental Health (NIMH) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that lower diagnosis rates for mental health conditions like anxiety and OCD in Black, Hispanic, and Asian/Pacific Islander autistic adults mean these groups have fewer symptoms. The authors note these disparities may reflect lower access to care or under-diagnosis rather than true prevalence differences.