In The Politics of Autism, I discuss the relationships of autism, class, race, and ethnicity.
The data also seem to show differences among demographic groups. Multiple studies find higher rates of autism among non-Hispanic whites than among Hispanics or African Americans. Why the disparity? White people tend to have higher income and educational levels, thus greater access to medical professionals and social networks that provide information about autism. Problems of cultural communication and clinician attitudes may delay diagnosis among nonwhites. In particular, primary care pediatricians find it more difficult to assess Spanish-speaking patients, and many do not do not offer screenings in Spanish.
At
Autism, Aisha Dickerson and colleagues have an article titled "Autism Spectrum Disorder Reporting in Lower Socioeconomic Neighborhoods."
The abstract:
Utilizing surveillance data from five sites participating in the Autism and Developmental Disabilities Monitoring Network, we investigated contributions of surveillance subject and census tract population sociodemographic characteristics on variation in autism spectrum disorder ascertainment and prevalence estimates from 2000 to 2008 using ordinal hierarchical models for 2489 tracts. Multivariable analyses showed a significant increase in ascertainment of autism spectrum disorder cases through both school and health sources, the optimal ascertainment scenario, for cases with college-educated mothers (adjusted odds ratio = 1.06, 95% confidence interval = 1.02–1.09). Results from our examination of sociodemographic factors of tract populations from which cases were drawn also showed that after controlling for other covariates, statistical significance remained for associations between optimal ascertainment and percentage of Hispanic residents (adjusted odds ratio = 0.93, 95% confidence interval = 0.88–0.99) and percentage of residents with at least a bachelor’s degree (adjusted odds ratio = 1.06, 95% confidence interval = 1.01–1.11). We identified sociodemographic factors associated with autism spectrum disorder prevalence estimates including race, ethnicity, education, and income. Determining which specific factors influence disparities is complicated; however, it appears that even in the presence of education, racial and ethnic disparities are still apparent. These results suggest disparities in access to autism spectrum disorder assessments and special education for autism spectrum disorder among ethnic groups may impact subsequent surveillance.
The conclusion of the article notes public health implications.
Using aggregate data from a multi-state surveillance study over five surveillance years, we identified demographic and socioeconomic factors associated with ASD prevalence estimates including race, ethnicity, education, and income. Specifically, children of Hispanic ethnicity do not experience optimal ascertainment through both school and healthcare sources as often as children of other ethnicities. Furthermore, maternal education and median income of neighborhoods increase the likelihood of case ascertainment through both sources. Determining which specific factors influence disparities is complicated; however, it appears that even in the presence of education, racial disparities are still apparent. Future research should further evaluate whether these patterns are still apparent after adjustment for private insurance. Furthermore, development of interventions for diagnosis of ASD should focus on targeting populations at greater risk of going unnoticed.
