Risk of hospitalization and death among autistic young people in England during the Covid-19 pandemic.

backgroundAutistic people experience increased health vulnerability and risk of premature mortality; the Covid-19 pandemic posed a serious health risk globally. The present study estimated risks of (i) first hospitalization, (ii) first hospitalization with a positive Covid-19 test, (iii) all-cause death, and (iv) Covid-19 associated death from 1 January 2020–31 March 2021 among autistic people compared to matched peers in England.

methodsWe leveraged National Health Service records from 45,756 individuals, including 15,252 autistic individuals, via the Clinical Practice Research Datalink. Participants were matched 1:2 on birth year (± 2 years), gender, and general practitioner practice to 30,504 non-autistic people. The sample primarily comprised males and younger individuals, with a median age of 19.0 years (IQR = 12.0 years), which was expected based on the demographics of clinically diagnosed autistic people. For all outcomes, cox proportional hazards regression models were performed, accounting for matching criteria of gender, birth year, and clustering across GP practices. Additional models adjusting for matching criteria, as well as socioeconomic status, intellectual disability, obesity, alcohol misuse, and smoking were performed to assess risks of all-cause and Covid-19 related hospitalizations. However, due to perfect separation, it was not possible to conduct analyses for mortality that were adjusted for additional covariates (beyond matching factors), and Covid-19 related mortality modelling only assessed risk for male individuals.

resultsAutistic individuals had increased likelihood of all-cause hospitalization (HR: 1.32, 95% CI: 1.22–1.42, p < .001) compared to matched peers, even after adjusting for intellectual disability, obesity, alcohol misuse, smoking, socioeconomic status, and matching factors. Autistic individuals had increased risk of Covid-19 related hospitalizations compared to matched non-autistic individuals when only accounting for matching factors; however, after adjusting for additional covariates of interest, autism did not remain a significant predictor of Covid-19 related hospitalization. In addition, while only models adjusting for matching factors could be performed, the results provide some evidence of heightened all-cause mortality risk for autistic individuals compared to matched non-autistic individuals during the covid period (HR = 2.47, 95% CI: 1.31–4.66, p = .005) and was inconclusive for Covid-19 associated deaths due to sparse events (HR = 1.26, 95% CI: 0.15–4.14, p = .79). LIMITATIONS: The study included a relatively young sample; thus, these results may be less applicable to older individuals and may underestimate effects for older individuals, as increasing age is a well-established risk factor for severe disease due to Covid-19 infection. In addition, due to low counts, analyses for mortality could only be adjusted for matching factors and the Covid-19 mortality analysis could only be conducted among males. Due to the nature of historically collected clinical data, we could not account for all potential confounders (e.g., residence type) and cannot eliminate the possibilities of missingness and/or provider differences in clinical coding.

conclusionsAutistic young people had increased risks of all-cause hospitalization, with some evidence of increased risks of Covid-19 related hospitalization and all-cause death, during the first 15 months of the Covid-19 pandemic compared to matched non-autistic young people. The study bolsters existing evidence of increased health vulnerability among autistic people, including within the Covid-19 period; however, the results do not provide clarity on whether autism remains an independent predictor of Covid-19 related hospitalization or death. These findings provide the first targeted, clinically-representative, and UK-specific statistics on the health vulnerability of autistic young people during the Covid-19 pandemic, and this issue must be addressed in individual patient care, as well as national and international public health policy.