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. 2024 Jul;54(7):2710-2718.
doi: 10.1007/s10803-023-05920-z. Epub 2023 May 4.

County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States

Jessica Bradshaw  1 , Jan M Eberth  2   3 , Anja Zgodic  3 , Alexis Federico  1 , Kate Flory  1 , Alexander C McLain  4
Affiliations

County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States

Jessica Bradshaw et al. J Autism Dev Disord. 2024 Jul.

Abstract

Prevalence estimates of autism spectrum disorder (ASD) point to geographic and socioeconomic disparities in identification and diagnosis. Estimating national prevalence rates can limit understanding of local disparities, especially in rural areas where disproportionately higher rates of poverty and decreased healthcare access exist. Using a small area estimation approach from the 2016-2018 National Survey of Children's Health (N = 70,913), we identified geographic differences in ASD prevalence, ranging from 4.38% in the Mid-Atlantic to 2.71% in the West South-Central region. Cluster analyses revealed "hot spots" in parts of the Southeast, East coast, and Northeast. This geographic clustering of prevalence estimates suggests that local or state-level differences in policies, service accessibility, and sociodemographics may play an important role in identification and diagnosis of ASD.County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States.

Keywords: autism prevalence; geographic disparities; national survey of children’s health; small area estimate.

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Conflict of interest statement

Conflict of Interest Disclosures Jan M. Eberth has received consulting fees from the National Network of Public Health Institutes. Alexander C. McLain has received consulting fees from the Bill and Melinda Gates Foundation and the World Health Organization. The other authors have no relevant conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Estimated Proportion of Children with ASD, County Level, 2016–2018
Note. The lightest color represents counties with an ASD estimate of 2.6% or lower. The second color in the gradient represents counties with an ASD estimate between 2.7% and 4.3%. The third color in the gradient represents counties with an ASD estimate between 4.4% and 8.1%. The darkest color represents counties with an ASD estimate of 8.2% or higher. The lighter the color of the county, the lower the ASD prevalence is. The darker the color of the county, the higher the ASD prevalence is. For example, counties in the southern part of the US have higher ASD prevalence than counties in western states.
Fig. 2
Fig. 2. Hot Spot Analysis for the Estimated Proportion of Children with ASD, County Level, 2016–2018
Note. Statistically significant clusters of high ASD rates (hot spots) are shown in orange and red. Significant clusters of low ASD rates (cold spots) are shown in shades of blue. Darker colors indicate greater certainty. The South Atlantic, Mid Atlantic, New England, and East South Central regional divisions are hot spots of ASD. West South Central appears as a cold spot of ASD.
See this image and copyright information in PMC

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