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. 2025 Feb;12(2):111-121.
doi: 10.1016/S2215-0366(24)00363-8. Epub 2024 Dec 19.

The global epidemiology and health burden of the autism spectrum: findings from the Global Burden of Disease Study 2021

Global Burden of Disease Study 2021 Autism Spectrum Collaborators
Collaborators

The global epidemiology and health burden of the autism spectrum: findings from the Global Burden of Disease Study 2021

Global Burden of Disease Study 2021 Autism Spectrum Collaborators. Lancet Psychiatry. 2025 Feb.

Abstract

Background: High-quality estimates of the epidemiology of the autism spectrum and the health needs of autistic people are necessary for service planners and resource allocators. Here we present the global prevalence and health burden of autism spectrum disorder from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 following improvements to the epidemiological data and burden estimation methods.

Methods: For GBD 2021, a systematic literature review involving searches in PubMed, Embase, PsycINFO, the Global Health Data Exchange, and consultation with experts identified data on the epidemiology of autism spectrum disorder. Eligible data were used to estimate prevalence via a Bayesian meta-regression tool (DisMod-MR 2.1). Modelled prevalence and disability weights were used to estimate health burden in years lived with disability (YLDs) as the measure of non-fatal health burden and disability-adjusted life-years (DALYs) as the measure of overall health burden. Data by ethnicity were not available. People with lived experience of autism were involved in the design, preparation, interpretation, and writing of this Article.

Findings: An estimated 61·8 million (95% uncertainty interval 52·1-72·7) individuals (one in every 127 people) were on the autism spectrum globally in 2021. The global age-standardised prevalence was 788·3 (663·8-927·2) per 100 000 people, equivalent to 1064·7 (898·5-1245·7) autistic males per 100 000 males and 508·1 (424·6-604·3) autistic females per 100 000 females. Autism spectrum disorder accounted for 11·5 million (7·8-16·3) DALYs, equivalent to 147·6 (100·2-208·2) DALYs per 100 000 people (age-standardised) globally. At the super-region level, age-standardised DALY rates ranged from 126·5 (86·0-178·0) per 100 000 people in southeast Asia, east Asia, and Oceania to 204·1 (140·7-284·7) per 100 000 people in the high-income super-region. DALYs were evident across the lifespan, emerging for children younger than age 5 years (169·2 [115·0-237·4] DALYs per 100 000 people) and decreasing with age (163·4 [110·6-229·8] DALYs per 100 000 people younger than 20 years and 137·7 [93·9-194·5] DALYs per 100 000 people aged 20 years and older). Autism spectrum disorder was ranked within the top-ten causes of non-fatal health burden for people younger than 20 years.

Interpretation: The high prevalence and high rank for non-fatal health burden of autism spectrum disorder in people younger than 20 years underscore the importance of early detection and support to autistic young people and their caregivers globally. Work to improve the precision and global representation of our findings is required, starting with better global coverage of epidemiological data so that geographical variations can be better ascertained. The work presented here can guide future research efforts, and importantly, decisions concerning allocation of health services that better address the needs of all autistic individuals.

Funding: Queensland Health and the Bill & Melinda Gates Foundation.

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Conflict of interest statement

Declaration of interests SB reports grants or contracts from the Japan Society for the Promotion of Science (JSPS), the Japanese Ministry of Education, Culture, Sports, Science and Technology, the Australian Academy of Science, Grant-in-Aid for Scientific Research (23KF0126), and JSPS International Fellowship (P23712), leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with Rotary District 9675, Sydney, Australia, the Global Health and Migration Hub Community, Global Health Hub Germany, Berlin, Germany, PLOS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Public Health, the Journal of Aging Research, Neurology International, Diagnostics, and BMC Medical Research Methodology, College of Reviewers, Canadian Institutes of Health Research, Government of Canada, the World Headache Society, Bengaluru, India, the Cariplo Foundation, Milan, Italy, the National Cerebral and Cardiovascular Center, Department of Neurology, Suita, Osaka, Japan, the Cardiff University Biobank, Cardiff, UK, and the Rotary Reconciliation Action Plan, all outside the submitted work. AC reports consulting fees from Knight Therapeutics, outside the submitted work. SC reports support for the present manuscript from the National Institute for Health and Care Research, grants or contracts from the National Institute for Health and Care Research and the European Research Agency, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from the Association for Child and Adolescent Mental Health, the British Association of Psychopharmacology, the The Canadian ADHD Resource Alliance, and Medice, all outside the submitted work. AF reports support for the present manuscript from the National Council for Scientific and Technological Development, Brazil. IF reports financial and logistic support from the Avicenna Medical and Clinical Research Institute, outside the submitted work. LM reports support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017) and payments made to their institution. FM reports support for the present manuscript from the National Institute for Health and Care Research Doctoral Fellowship (300957). RFP-A reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Angelini, Casen-Recordati, Exeltis, Rubió, Servier, Lundbeck, Takeda, and Neuraxpharm, patents planned, issued, or pending with Angelini, Italfarmaco, Advanz Pharma, Takeda, and Lundabeck, all outside the submitted work. GP reports royalties or licences from Editora Manole, consulting fees from EMS Pharmaceuticals, Aspen, and Medice, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Ache, Abbott, Adium, Libbs, and Takeda, all outside the submitted work. AR reports other financial and non-financial support from Avicenna Medical and Clinical Research Institute, outside the submitted work. LR reports support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017) and payments made to their institution. JPS reports support for the present manuscript from the Portuguese Foundation for Science and Technology. LBS-T reports grants or contracts from the University Research Council of the Ateneo de Manila University (PhP429,500, P2,000,000, Php 597250, Php1,500,000) and Nestlé Clinical Development Unit (Php8,788,216.70), payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from the Department of Science and Technology, Philippines, the Department of Health, Philippines, Wyeth Philippines, and Bayer Philippines, support for attending meetings or travel from the Institute of Functional Medicine to attend the 2024 Annual International Conference, leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with Philippines Society for Developmental and Behavioral Pediatrics and Circle of Hope Community Services, and stock or stock options in The Medical City, Great Valley Medical Center, OTSRI, all outside the submitted work. RT-S reports grants or contracts from the Valencian Regional Government's Ministry of Education (PROMETEO/CIPROM/2022/58) and the Spanish Ministry of Science, Innovation, and Universities (PID2021-129099OB-I00), all outside of the submitted work. ST reports grants or contracts from the Department of Health and Social Care, NHS Digital (England), leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with the Academic Secretary for the Neurodevelopmental Psychiatry Special Interest Group and Psychiatry of Intellectual Disability Faculty at the Royal College of Psychiatrists, is an Editorial Board Member for BMC Psychiatry, Advances in Autism, Advances in Mental Health and Intellectual Disability, and Progress in Neurology and Psychiatry, and is the Editor of Psychiatry of Intellectual Disability Across Cultures (Oxford University Press), all outside the submitted work. MZ is an AstraZeneca employee. All other authors declare no competing interests. The views expressed in this Article are those of the authors and not necessarily those of UK National Health Service (NHS), National Institute for Health and Care Research, or the Department of Health and Social Care.

Figures

Figure 1
Figure 1
Number of studies per country used to inform the estimation of the prevalence of autism spectrum disorder Locations coloured grey did not have eligible epidemiological data on autism spectrum disorder. Dotted lines indicate disputed territories.
Figure 2
Figure 2
Prevalence of autism spectrum disorder per 100 000 people, by age and sex, 2021 The thick line represents the prevalence of autism spectrum disorder by age and the ribbon around this line represents its 95% UI. UI=uncertainty interval.
Figure 3
Figure 3
Age-standardised DALY rates per 100 000 people for autism spectrum disorder by quintile, 2021 Dotted lines indicate disputed territories. Geographical variation in DALYs were informed by location-specific prevalence estimates modelled within DisMod-MR 2.1. DALY=disability-adjusted life-year.
Figure 4
Figure 4
Global DALYs attributable to autism spectrum disorder, by age and sex, 2021 Blue bars represent the estimated number of DALYs (in thousands) attributable to autism spectrum disorder by age. DALY=disability-adjusted life-year.
See this image and copyright information in PMC

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