Explaining the Increase in the Prevalence of Autism Spectrum Disorders

作者：Stefan Nygaard Hansen, Diana Schendel, Erik Thorlund Parner · 发表于：Archives of Pediatrics and Adolescent Medicine · 年份：2014 · DOI：10.1001/jamapediatrics.2014.1893 · 被引用次数：460 · 研究领域：Autism Spectrum Disorder Research、Family and Disability Support Research、Cerebral Palsy and Movement Disorders

IMPORTANCE: The prevalence of autism spectrum disorders (ASDs) has increased markedly in recent decades, which researchers have suggested could be caused in part by nonetiologic factors such as changes in diagnosis reporting practices. To our knowledge, no study has quantified the degree to which changes in reporting practices might explain this increase. Danish national health registries have undergone a change in diagnostic criteria in 1994 and the inclusion of outpatient contacts to health registries in 1995. OBJECTIVE: To quantify the effect of changes in reporting practices in Denmark on reported ASD prevalence. DESIGN, SETTING, AND PARTICIPANTS: We used a population-based birth cohort approach that includes information on all individuals with permanent residence in Denmark. We assessed all children born alive from January 1, 1980, through December 31, 1991, in Denmark (n=677915). The children were followed up from birth until ASD diagnosis, death, emigration, or the end of follow-up on December 31, 2011, whichever occurred first. The analysis uses a stratified Cox proportional hazards regression model with the changes in reporting practices modeled as time-dependent covariates. EXPOSURES: The change in diagnostic criteria in 1994 and the inclusion of outpatient diagnoses in 1995. MAIN OUTCOMES AND MEASURES: Autism spectrum disorders. RESULTS: For Danish children born during the study period, 33% (95% CI, 0%-70%) of the increase in reported ASD prevalence could be explai...