The life expectancy of autistic people has remained surprisingly difficult to measure. Now, one of the largest studies of its kind has shed light on the issue—and identified several factors that may be shortening lives. Researchers at Columbia University Mailman School of Public Health and University of Colorado Anschutz found that people with autism spectrum disorder (ASD) enrolled in Medicaid (the U.S. public health insurance program for low-income individuals and people with disabilities) had a life expectancy at birth of about 65 years, nearly 14 years shorter than that of the U.S. general population.
Rather than being driven by a single health issue, the significant age gap appears to stem from elevated risks across a wide range of medical conditions and causes of death. The study, published in JAMA Network Open, analyzed records from more than 2 million autistic Medicaid beneficiaries across all 50 states and Washington, D.C., spanning 2000 to 2020. Researchers linked Medicaid data with mortality records from the National Death Index to examine both life expectancy and causes of death.
Overall, autistic Medicaid beneficiaries had a life expectancy of 64.9 years. That was 5.6 years shorter than the overall Medicaid population and 13.8 years shorter than the U.S. population as a whole. The researchers found that autistic people faced significantly higher mortality risks from many different diseases and health conditions.
Particularly striking were higher death rates linked to influenza, malnutrition, pneumonia, respiratory diseases and neurological disorders. Accidental drowning and other non-transport accidents were also substantially more common causes of death than expected. Jessica McCarthy, founder and clinical director of Elements Psychological Services, said the findings should not be interpreted to mean autism itself shortens lives.
"People don’t die earlier as a function of being autistic," McCarthy told Newsweek. "They die from lack of access to care, collaboration of care amongst practitioners, accidents such as falls or drownings, malnutrition and swallowing issues, and dismissing the onset or change in physical symptoms or functional ability as behavioral instead of medical." She said more accessible healthcare, better preventive care and improved communication between medical, behavioral health and allied health providers could help narrow the gap. According to the study, autistic Medicaid beneficiaries were more than 10 times as likely to die from influenza as expected, more than seven times as likely to die from malnutrition and nearly seven times as likely to die from pneumonitis caused by inhaling food, liquid or other substances into the lungs.
McCarthy said those findings point to potentially modifiable risk factors rather than unavoidable consequences of autism. "Some of the largest disparities were in deaths related to influenza, malnutrition, aspiration-related infection and inflammation, pneumonia, drowning, falls, and other accidents," she said. "That points us toward potentially modifiable factors: access to preventative and collaborative care, recognition and communication of medical symptoms, feeding and swallowing issues, safety supports, co-occurring conditions and whether medical environments are actually accessible to autistic people." The findings suggest that the shorter life expectancy is not primarily the result of autism itself, but rather the accumulation of health challenges and vulnerabilities that can accompany the condition.
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