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Sunday, April 9, 2023

Autism and COVID Risk

In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families. Those challenges get far more intense during disasters.  And coronavirus proved to be a disaster

At The Journal of Autism and Developmental Disorders, Amber Davis and colleagues have an article titled "Hospitalization and Mortality for Insured Patients in the United States with COVID-19 with and without Autism Spectrum Disorder."
This study is a novel investigation of the odds of COVID-19 related hospitalization and mortality among individuals with ASD during the most acute phase of the global pandemic The study considers the role of multiple sociodemographic factors and comorbidities, supported the hypothesis that individuals with ASD had higher odds of COVID-19 related hospitalization and mortality than individuals without ASD. Co-morbidities also played a significant role in increasing the odds of COVID-19 related hospitalization and mortality. Individuals with ASD have been reported to have higher risks of having at least one additional comorbidity (Supekar et al., 2017). Few studies have analyzed the impact of comorbidities on hospitalization and mortality for persons with ASD and COVID-19. This study sought to examine the hypothesized disproportionate hospitalizations and fatal outcomes due COVID-19 among individuals with ASD. Results of the study may also suggest that individuals with ASD may experience greater risk for severe COVID-19 outcomes, possibly due to increased prevalence of comorbidities (Hirvikoski et al., 2016; Khan et al., 2020; Singh et al., 2020).

After adjusting for comorbidities, individuals with ASD had greater odds of mortality compared to the general population of COVID-19 positive patients. There is mounting research evidence that physiological ASD profiles can include underlying immunological deficiencies related to neuro-inflammation and neuro-immune abnormalities (Masi et al., 2017; Siniscalco et al., 2018). Consistent with previous research, comorbidities played a significant independent role in increasing the odds of hospitalizations and were more strongly related to hospitalizations associated with COVID-19 than ASD, given that COVID-19 related hospitalization and ASD were not significant after adjusting for comorbid illness. Although mortality attributable to COVID-19 remained significant, the odds of mortality associated with ASD were reduced after controlling for comorbidities.

Immunological profiles of persons with ASD may play a role in the increased risk for mortality for the population of individuals with ASD. The link between autism and comorbidity burden, for example intellectual disability, may increase the risk of poor health outcomes due to decreased access and understanding of infection mitigation strategies. Severe autism is associated with obesity (Healy et al., 2019), which has been linked to negative outcomes associated with COVID-19 and may increase severe COVID-19 related outcomes for this population as well. ASD has varied phenotypic, cognitive, and neurobehavioral characteristics that should be taken into consideration when providing healthcare.

Societal context is an additional layer for understanding increased risk for comorbidity in ASD groups including societal exclusion and more sedentary lifestyles. Although our study did not look at such interactions, the impact of ableism, racism, and poverty may link to disproportionate health outcomes for multiply marginalized individuals. These factors may increase mental health disorders and also contribute to negative coping styles (i.e., withdrawn behaviors, depression, overconsumption of unhealthy foods, smoking, and lack of exercise).