Health conditions and service use of autistic women and men: A retrospective population-based case-control study.

The study used administrative records, so it captured coded diagnoses and billed visits, not severity, quality of care, patient-reported needs, or unmeasured confounders. It used sex assigned at birth and did not collect gender identity, so transgender and nonbinary autistic adults were not analyzed separately. It did not collect race or ethnicity, so differences related to these factors cannot be examined. Autistic women may be underdiagnosed and may have been missed if they had no coded health or disability-support record. Ontario outpatient billing permits only one code per visit, which may hide multiple conditions or reasons for a visit. Results could not be stratified by presence or absence of intellectual disability. The data were from records before 2010, with different look-back periods for different outcomes. Only conditions with validated administrative algorithms were included, so other common autism-associated conditions were not assessed. The study did not examine services outside formal health care, such as social or educational supports. Members of the autistic and autism communities were not directly involved.

The authors disclosed receipt of financial support. Funding came from Canadian Institutes of Health Research grants and fellowships, ICES, and Ontario ministries. ICES is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. Parts of the material used data provided by Ontario ministries and postal code conversion files licensed from Canada Post and Statistics Canada. No commercial sponsor is named in the funding statement.

Do not read the higher service use as proof that autistic adults are receiving better care. The study counted recorded diagnoses and visits, not quality, severity, or unmet need, and it did not include gender identity or race.