The National Autism Indicators Report on Income and Race in Autism Healthcare

The National Autism Indicators Report, about how race and income affect the health status of individuals with autism was recently published in the United States.

To gain a better understanding of income disparities between children with and without autism and how those disparities affect health, data from the National Survey of Children’s Health 2017-2020 were evaluated.

More children with autism in the US lived in poor (25% vs 19%) or near-poor (28% vs 22%) households and fewer in middle-income (26% vs 28%) or high-income (21% vs 31%) households compared with children without autism, respectively.

Among all children with autism, Black, Indigenous, and People of Color (BIPOC) children were more likely to live in low-income households compared with White children, in which the proportion of BIPOC children with autism decreased as household income increased and the proportion of White children increased.

Children with autism were more likely to have fair or poor (8% vs 1%), good (26% vs 25%), or very good (36% vs 25%) health status and, fewer had excellent health status (31% vs 65%) compared with children without autism. Stratified by household income, fewer children with autism who were poor (23%) or near-poor (23%) had excellent health compared with children from high-income households (41%).

Across incomes, Black children with autism had the highest rate of excellent health (31%) followed by other ethnicities (30%), White (27%), and Hispanic (26%) children.

The caregivers of Black children reported the highest rate of severe autism (22%) and White caregivers, the least (9%).

Compared with children without autism, both children with autism from lower- and higher-income households reported more chronic health conditions involving headaches or body pain, breathing/respiratory problems, stomach/intestinal problems, eating or swallowing, decayed teeth or cavities, toothaches, and bleeding gums.

More children with autism had a medical visit in the previous year (88% vs 80%) and used mental healthcare (44% vs 9%) but fewer received dental care (81% vs 87%) compared with the nonautistic population, respectively. Despite increased healthcare utilization, children with autism were more likely to not receive healthcare when it was needed in the past year (12% vs 3%).

In autism, fewer Black (85%) and Hispanic (82%) children with autism had a medical visit in the previous year than White (91%) or other ethnicity (91%) children. Hispanic children (79%) were least likely to receive preventative medical care compared with Black (85%), other ethnicity (90%), or White (91%) children.

Fewer children with autism were covered by private insurance (41% vs 59%) and had insurance that always covered needed services (49% vs 63%) compared with nonautistic children.

More families with autism reported ≥$1000 in out-of-pocket medical expenses than families without autism (22% vs 13%).

The report authors concluded, “We found that household income appears to be a very important factor for understanding health disparities for people with autism, as it is associated with differences in health status, insurance coverage, medical expenditures, and healthcare access. The report also shows that autism, poverty, and race/ethnicity appear to be risk factors for poor health and healthcare outcomes individually and in combination.”

Reference

Anderson KA, Roux AM, Steinberg H, et al. National Autism Indicators Report: The intersection of autism, health, poverty and racial inequity. Philadelphia: Policy and Analytics Center and Life Course Outcomes Research Program, AJ Drexel Autism Institute, Drexel University, April 2022.