County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States.
Jessica Bradshaw, Jan M Eberth, Anja Zgodic and 3 others
PMID 37142898WHAT IT FOUND
County-level estimates show autism prevalence varies significantly by geography, race, and socioeconomic status.
Rates were higher in the Northeast and Southeast, lower in the West and Midwest. Black and Hispanic children had higher estimated prevalence than white children. Children of parents with college degrees had lower rates than those with less education.
Key findings
01National estimated prevalence of ASD was 3.29%, with significant regional variability ranging from 2.71% in the West South Central region to 4.38% in the Mid Atlantic.
02Nationally, ASD prevalence was 3.82% among Black children, 3.36% among Hispanic children, and 2.87% among white children.
03ASD prevalence among children with parents holding a college degree was 2.62%, compared to 4.04% for children whose parents had not completed high school.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study relies on parent report of a prior diagnosis, which may miss children who have not yet been diagnosed or those misdiagnosed. The sample was limited to children aged 5-17, excluding younger children. The analysis could not include all potential predictors (e.g., intellectual disability) because county-level population data for those variables was unavailable. The estimates are model-based and may differ from direct surveillance data (e.g., ADDM Network) due to different ascertainment methods. The study describes prevalence estimates, not causal factors; geographic disparities may reflect differences in service access and diagnosis rates rather than true biological variation.
Declared interests
One author received consulting fees from the National Network of Public Health Institutes. Another received consulting fees from the Bill and Melinda Gates Foundation and the World Health Organization. The study used data from the Health Resources and Services Administration (HRSA).
The easy way to misread this
Do not interpret the geographic variations in prevalence as differences in the actual incidence of autism. These estimates reflect reported diagnoses, which are heavily influenced by access to care, screening practices, and insurance coverage. A lower rate in a 'cold spot' likely indicates fewer diagnoses, not fewer children with autism.