Differences raciales/ethniques dans les diagnostics psychiatriques et medicaux chez les adultes autistes

Titre original en anglais : Racial/Ethnic Differences in Psychiatric and Medical Diagnoses Among Autistic Adults

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Ames, J., Morgan, E., Giwa Onaiwu, M., Qian, Y., Massolo, M. L., & Croen, L. A. (2022). Racial/Ethnic Differences in Psychiatric and Medical Diagnoses Among Autistic Adults. Autism in Adulthood, 4(4), 290-305. https://doi.org/10.1089/aut.2021.0083

Date de publication: 08/09/2022 Ajout dans AutiHub: 05/07/2026 Type: Article Langue de l’article: Anglais
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Auteurs

Auteur·ices des publications
6
Auteur·ices de la publication identifié·es comme autistes
1 / 6 (16,7 %)
  1. Jennifer Ames
  2. Elizabeth Morgan
  3. Morénike Giwa Onaiwu *
  1. Yinge Qian
  2. Maria L Massolo
  3. Lisa A. Croen

Résumé

Contexte : Les disparites raciales/ethniques dans l'acces aux services diagnostiques sont generalisees chez les enfants autistes. Cependant, peu d'etudes ont examine les disparites raciales/ethniques en matiere de sante chez les adultes autistes, qui presentent couramment des taux plus eleves de problemes de sante que les adultes non autistes. Nous avons vise a examiner l'intersection de l'autisme et de la race/ethnicite en association avec les diagnostics psychiatriques et medicaux. Methodes : La population de l'etude comprenait des membres adultes de Kaiser Permanente Northern California inscrits de 2008 a 2012. Nous avons identifie 1507 adultes ayant un diagnostic d'autisme documente dans leurs dossiers medicaux electroniques. Nous avons echantillonne un groupe temoin apparié d'adultes sans diagnostic d'autisme (N = 15 070) selon un ratio de 10:1. Notre echantillon etait compose de 46 % de Blancs, 17 % d'Hispaniques, 16 % d'Asiatiques, 7 % de Noirs et 14 % d'autres races/ethnicites. Nous avons compare les diagnostics de sante (a) entre les adultes autistes et non autistes au sein de strates de race/ethnicite et (b) entre les races/ethnicites au sein de strates d'adultes autistes et non autistes. Enfin, nous avons examine l'interaction entre l'autisme et la race/ethnicite sur des echelles multiplicatives et additives. Resultats : Les adultes autistes etaient plus susceptibles de recevoir un diagnostic de la plupart des affections medicales et psychiatriques que leurs homologues non autistes de la meme race/ethnicite. Parmi les adultes autistes, les adultes noirs, hispaniques et asiatiques etaient moins susceptibles de recevoir un diagnostic d'affections psychiatriques, et les adultes autistes noirs et hispaniques etaient plus susceptibles de recevoir un diagnostic d'obesite que leurs homologues blancs. Dans les modeles d'interaction, nous avons constate que les adultes noirs et autistes etaient disproportionnellement moins susceptibles de recevoir un diagnostic d'affections psychiatriques et de maladie autoimmune, et plus susceptibles de recevoir un diagnostic d'hypertension que prevu. Conclusion : Les vulnerabilites en matiere de sante peuvent etre cumulees a l'intersection de l'autisme et de la race/ethnicite. Les recherches futures devraient continuer a appliquer une perspective intersectionnelle afin de comprendre et de traiter ces disparites. Nos resultats sous-estiment probablement les disparites de sante existant chez les adultes autistes non assures et chez ceux vivant dans d'autres regions des Etats-Unis. Resume a l'intention de la communaute Pourquoi cette question est-elle importante ? Tres peu d'etudes ont examine comment la combinaison des identites autiste et raciale/ethnique d'une personne affecte sa sante a l'age adulte. Les experiences doubles de capacitisme et de racisme structurel peuvent avoir un effet negatif plus important sur la sante des personnes autistes racisees que l'une ou l'autre experience prise isolement. Il est important d'identifier les disparites potentielles de sante afin qu'elles puissent etre traitees. Quel est l'objectif de cette etude ? Nous voulions comprendre si les adultes autistes racises etaient plus susceptibles de recevoir un diagnostic d'affections medicales et psychiatriques que leurs pairs non autistes et/ou blancs. Qu'ont fait les chercheurs ? Nous avons etudie un groupe diversifie de 1507 adultes autistes et de 15 070 adultes non autistes qui recevaient tous des soins de sante du meme grand regime de sante en Californie. Nous avons examine les dossiers de sante electroniques afin de determiner si les diagnostics de problemes de sante differaient selon le statut d'autisme et la race/ethnicite. Nous avons ensuite examine si les personnes autistes racisees recevaient des diagnostics de ces affections de maniere disproportionnee par rapport aux autres groupes. Quels ont ete les resultats de l'etude ? Au sein de chaque groupe racial/ethnique, les adultes autistes etaient plus susceptibles que les adultes non autistes de recevoir un diagnostic de la plupart des affections medicales et psychiatriques. Parmi le groupe autiste, les adultes noirs, hispaniques et asiatiques etaient moins susceptibles de recevoir un diagnostic d'affections psychiatriques que les adultes blancs. Nous avons observe des differences similaires dans les diagnostics psychiatriques selon la race/ethnicite chez les adultes non autistes. De plus, les profils diagnostiques chez les adultes autistes et noirs suggeraient que ce groupe pourrait rencontrer des difficultes particulieres pour obtenir des diagnostics de sante mentale et de maladies autoimmunes. Ils pourraient egalement presenter un risque plus eleve d'hypertension. Qu'ajoutent ces resultats a ce qui etait deja connu ? Des etudes precedentes ont observe des disparites raciales/ethniques tant dans la sante mentale que dans l'acces aux soins de sante chez les enfants autistes. Cette etude suggere que des disparites raciales/ethniques, notamment dans les soins de sante mentale, peuvent egalement exister chez les adultes autistes. Quelles sont les faiblesses potentielles de l'etude ? En tant qu'etiquette sociale generale, la race/ethnicite ne nous renseigne guere sur les experiences vecues des personnes. Les etudes futures devraient remplacer la race/ethnicite par des mesures plus utiles de notre environnement social, notamment les opportunites economiques et les experiences de racisme structurel. En outre, les dossiers de sante peuvent representer imparfaitement la survenue reelle de problemes de sante. Par exemple, nous ne pouvons pas determiner a partir de cette etude si les personnes autistes racisees connaissent reellement moins de problemes psychiatriques, sont moins susceptibles de consulter un medecin, ou sont plus susceptibles de voir leurs problemes non detectes par les medecins. Enfin, comme nos resultats proviennent d'une population assuree, nous avons probablement sous-estime les disparites de sante qui existent chez les adultes autistes qui ne disposent pas d'une couverture d'assurance ou d'un acces aux soins de sante regulier. Comment ces resultats aideront-ils les adultes autistes maintenant ou a l'avenir ? Nous esperons que cette etude mettra en evidence la necessite d'accorder une plus grande attention aux risques uniques pour la sante a l'intersection de l'autisme et de la race/ethnicite chez les adultes. Grace a davantage de recherche et de plaidoyer, nous pouvons accroitre la sensibilisation et la comprehension de ces disparites potentielles de sante. Cela conduira a des changements favorisant un acces plus egal aux soins de sante et un plus grand bien-etre chez les personnes autistes racisees.

Background: Racial/ethnic disparities in access to diagnostic services are pervasive for autistic children. However, a few studies have examined racial/ethnic health disparities among autistic adults, who commonly experience higher rates of health conditions than non-autistic adults. We aimed at examining the intersection of autism and race/ethnicity in association with psychiatric and medical diagnoses. Methods: The study population included adult members of Kaiser Permanente Northern California enrolled from 2008 to 2012. We ascertained 1507 adults who had an autism diagnosis documented in their electronic medical records. We sampled a matched control group of adults without an autism diagnosis ( N = 15,070) at a 10:1 ratio. Our sample was 46% White, 17% Hispanic, 16% Asian, 7% Black, and 14% other race/ethnicity. We compared health diagnoses (a) between autistic and non-autistic adults within strata of race/ethnicity and (b) across race/ethnicity within strata of autistic and non-autistic adults. Lastly, we examined the interaction between autism and race/ethnicity on both multiplicative and additive scales. Results: Autistic adults were more likely to be diagnosed with most medical and psychiatric conditions compared with their non-autistic counterparts of the same race/ethnicity. Among autistic adults, Black, Hispanic, and Asian adults were less likely to be diagnosed with psychiatric conditions and Black and Hispanic autistic adults were more likely to be diagnosed with obesity than their White counterparts. In interaction models, we found that adults who were Black and autistic were disproportionately less likely to be diagnosed with psychiatric conditions and autoimmune disease and more likely to be diagnosed with hypertension than expected. Conclusion: Health vulnerabilities may be compounded at the intersection of autism and race/ethnicity. Future research should continue to apply an intersectional lens toward understanding and addressing these disparities. Our findings likely underestimate the health disparities that exist in uninsured autistic adults and those living in other parts of the United States. Community brief Why is this an important issue? Very few studies have looked at how the combination of a person's autistic and racial/ethnic identities affects their health in adulthood. Dual experiences of ableism and structural racism may have a larger negative effect on the health of autistic people of color than either one experience alone. It is important to identify potential health disparities so that they can be addressed. What is the purpose of this study? We wanted to understand whether autistic adults of color were more likely to be diagnosed with medical and psychiatric conditions than non-autistic and/or White peers. What did the researchers do? We studied a diverse group of 1507 autistic adults and 15,070 non-autistic adults who all received health care from the same large, health plan in California. We examined electronic health records to determine whether diagnoses of health conditions differed by autism status and race/ethnicity. We then looked at whether autistic people of color were disproportionately diagnosed with these conditions compared with other groups. What were the results of the study? Within every racial/ethnic group, autistic adults were more likely than non-autistic adults to be diagnosed with most medical and psychiatric conditions. Among the autistic group, Black, Hispanic, and Asian adults were less likely to be diagnosed with psychiatric conditions compared with White adults. We saw similar differences in psychiatric diagnoses by race/ethnicity among non-autistic adults. Further, the diagnostic patterns among adults who were autistic and Black suggested that this group may experience unique difficulties receiving mental health and autoimmune diagnoses. They also may be at a higher risk of hypertension. What do these findings add to what was already known? Previous studies have found racial/ethnic disparities in both mental health and access to health care among autistic children. This study suggests that racial/ethnic disparities, especially in mental health care, may also exist among autistic adults. What are potential weaknesses in the study? As a broad social label, race/ethnicity does not tell us much about people's lived experiences. Future studies should replace race/ethnicity with more useful measures of our social environment, including economic opportunity and experiences of structural racism. In addition, health records may imperfectly represent the actual occurrence of health conditions. For example, we cannot tell from this study whether autistic people of color actually experience fewer psychiatric problems, are less likely to visit the doctor, or are more likely to have their problems missed by doctors. Lastly, because our findings are from an insured population, we have likely underestimated the health disparities that exist among autistic adults who do not have consistent insurance coverage or health care access. How will these findings help autistic adults now or in the future? We hope this study highlights the need for greater attention to the unique health risks at the intersection of autism and race/ethnicity in adults. Through more research and advocacy, we can increase awareness and understanding of these potential health disparities. This will lead to changes that promote more equal access to health care and greater well-being among autistic people of color.

Bibliographie citée par cette référence

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Vue d’ensemble de l’inclusion dans la bibliographie

Ces indicateurs décrivent la bibliographie citée importée pour cette publication. Les métriques de références citées utilisent le total des références citées comme dénominateur. Les métriques d’auteurices cité·es indiquent si elles utilisent toutes les occurrences d’auteurices cité·es ou seulement les occurrences rattachées à des auteurices déjà intégré·es à la base de données AutiHub. Ils utilisent les rattachements mis en cache entre les auteurices cité·es et les auteurices intégré·es à la base de données AutiHub. Dernier calcul : 16/08/2026 11:30.

Références citées
86
Nombre total de références citées intégrées pour cette publication.
Références citées avec un·e auteur·ice identifié·e comme autiste
8 / 86 (9,3 %)
Occurrences d’auteur·ices cité·es identifié·es comme autistes
15 / 349 (4,3 %)
Parmi les occurrences rattachées à des auteurices intégré·es à la base de données AutiHub : 15 / 78 (19,2 %). Auteurices cité·es distinct·es identifié·es comme autistes : 9 / 311 (2,9 %).
Occurrences citées rattachées à la base AutiHub
78 / 349 (22,3 %)
Auteurices cité·es distinct·es rattaché·es : 51 / 311 (16,4 %)
Occurrences rattachées, non identifiées comme autistes
63 / 78 (80,8 %)
Parmi les seules occurrences rattachées. Sur l’ensemble des occurrences d’auteurices cité·es : 63 / 349 (18,1 %). Auteurices cité·es distinct·es rattaché·es, non identifié·es comme autistes : 42 / 51 (82,4 %).
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