Autism Spectrum Disorder Incidence by Age and Sex in a US Health Care System, 2016 to 2024

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Messias, E., Casanova, E., Huang, R., Battula, S., Loftin, R., Walsh, M., & Lin, P. I. (2026). Autism Spectrum Disorder Incidence by Age and Sex in a US Health Care System, 2016 to 2024. JAMA Network Open, 9(7), e2624561. https://doi.org/10.1001/jamanetworkopen.2026.24561

Publication date: 22 Jul 2026 Added to AutiHub: 9 Oct 2026 Type: Article Article language: English
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Authors

Publication authors
7
Publication authors identified as autistic
1 / 7 (14.3%)
  1. Erick Messias
  2. Emily Casanova *
  3. Regina Huang
  4. Siri Battula
  1. Rachel Loftin
  2. McKenna Walsh
  3. Ping-I Lin

Abstract

Importance Despite the increasing prevalence of autism spectrum disorder (ASD) in the US, underlying temporal trends in newly recorded diagnoses remain poorly understood. Objective To evaluate age- and sex-specific incidence trends of ASD from 2016 to 2024 and quantify the temporal patterns before and after the COVID-19 pandemic and diagnostic substitution. Design, Setting, and Participants This retrospective cohort study used electronic health record data from a large US health care system. Analyses were conducted from October to December, 2025. The study population included 171 134 participants (stratified as children [0-9] years, adolescents [10-18] years, and adults [≥19] years) who maintained continuous engagement with the health care system, defined as having at least 1 clinical encounter annually from 2016 to 2024. Main Outcomes and Measures The primary outcome was the annual incidence of newly recorded diagnoses of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes F84.0 and F84.5. Temporal trends were analyzed using joinpoint regression to calculate annual percentage changes (APCs) and identify significant inflection points. Results Among 171 134 participants (mean [SD] age, 26.78 [16.38], 63.8% female), females received autism diagnoses a mean (SD) of 3.4 years later than males (age at diagnosis, 15.7 years for female individuals vs 12.3 years for male individuals; P <.001). Male autism incidence remained stable or declined 2016 to 2024; female incidence increased significantly post-2020 (APC, 19.0%; 95% CI, 12.1% to 33.4%). In the pediatric cohort, decreasing annual incidence among males (APC, −2.0%; 95% CI, −3.7% to −0.3%; to APC, −2.0%, 95% CI, −3.7% to −0.3%) alongside increasing incidence for females since 2020 (APC, 17.4; 95% CI, 9.0% to 45.3%). In adolescent males, incidence declined from 2016 to 2018 (APC, −29.6%; 95% CI, −48.9% to −1.2%), and stabilized from 2018 to 2024. In adolescent females, autism incidence increased significantly between 2020 and 2024 (APC, 22.3%; 95% CI, 6.1% to 62.8%). In adult males, autism incidence showed a downward trend in the 2016 to 2024 period, while in adult females, the APC from 2016 to 2024 was positive, but the finding was not statistically significant (APC, 8.0%; 95% CI, −0.9% to 20.0%). Conclusions and Relevance In this cohort study, ASD diagnoses increased disproportionately among females after 2020 while remaining stable or declining among males. These patterns suggested that increasing ASD prevalence reflected improved identification of historically underrecognized presentations rather than a uniform population-level increase. These findings highlight the need for screening strategies that address sex-specific presentations.

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These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 27 Oct 2026 01:01.

Cited references
18
With a DOI
18
Without a DOI, from raw bibliography text
0
0 / 18 (0.0%) cited references include at least one author identified as autistic.
References with data to complete
0 / 18 (0.0%)
References with detected author names
18 / 18 (100.0%)
Without detected author names
0
Without a structured title
0
Without a stable identifier
0
References with raw author names still to review
0
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
176
From DOI or external metadata
176
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
0
38 / 176 (21.6%) names are linked to an author already present in AutiHub. 138 / 176 (78.4%) names are not yet linked.
Names linked to a person identified as autistic
0 / 176 (0.0%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 0 / 38 (0.0%). Distinct people identified as autistic: 0 / 158 (0.0%).
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