Neighborhood Socioeconomic Context and Autism Spectrum Disorder

Abstract

Background and Aim: Neighborhood deprivation and autism spectrum disorder (ASD) risk associations are inconsistent across countries with different health systems. We examined associations between neighborhood SES during pregnancy and ASD in a U.S. mother-child cohort with good health care access. Methods: This retrospective cohort study included 318,826 children born in Kaiser Permanente Southern California (KPSC) hospitals in 2001-2014. Children were followed through electronic medical records until ASD diagnosis, non-KPSC membership, death, or December 31, 2019, whichever came first. Birth addresses were matched to U.S. Census tracts. A neighborhood deprivation index was developed using principal component analysis of seven census tract-level deprivation indicators (%poverty, %unemployment, %public assistance, %female-headed households, %less than high school, %bachelor and post, %professional occupation) obtained from the 2005-2009 and 2010-2014 American Community Survey and 2000 census. Hazard ratios (HRs) of ASD associated with neighborhood deprivation were scaled to interquartile range (IQR) and estimated using Cox regression models adjusted for birth year, child sex, maternal age, parity, maternal history of comorbidity, maternal race/ethnicity and education. Effect modification by maternal race, education, and child sex was assessed. Results: During follow-up 6,357 children (1.99%) had ASD diagnosis over a median of 9.0 follow-up years. Pregnancy residence in more deprived neighborhoods was associated with child ASD risk [HR=1.07 (95% confidence interval 1.02, 1.11) per deprivation IQR increase]. Maternal race interacted with neighborhood deprivation (p<0.05); deprivation-associated ASD risk was only observed among the White population [HR = 1.24 (1.11, 1.37)]. Results were consistent in alternative specifications of neighborhood deprivation. Conclusions: Children living in more deprived neighborhoods had a higher risk of ASD among a population with uniform health care access. This association was mainly observed in White populations, suggesting that in other races factors such as systemic racism may overwhelm effects of ASD-associated neighborhood deprivation. Keywords: Neighborhood deprivation, Autism