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Incidence, prevalence, and global burden of autism spectrum disorder from 1990 to 2019 across 204 countries

Abstract

Autism spectrum disorder (ASD) substantially contributes to the burden of mental disorders. Improved awareness and changes in diagnostic criteria of ASD may have influenced the diagnostic rates of ASD. However, while data on trends in diagnostic rates in some individual countries have been published, updated estimates of diagnostic rate trends and ASD-related disability at the global level are lacking. Here, we used the Global Burden of Diseases, Injuries, and Risk Factors Study data to address this gap, focusing on changes in prevalence, incidence, and disability-adjusted life years (DALYs) of ASD across the world. From 1990 to 2019, overall age-standardized estimates remained stable globally. Both prevalence and DALYs increased in countries with high socio-demographic index (SDI). However, the age-standardized incidence decreased in some low SDI countries, indicating a need to improve awareness. The male/female ratio decreased between 1990 and 2019, possibly accounted for by increasing clinical attention to ASD in females. Our results suggest that ASD detection in low SDI countries is suboptimal, and that ASD prevention/treatment in countries with high SDI should be improved, considering the increasing prevalence of the disorder. Additionally, growing attention is being paid to ASD diagnosis in females, who might have been left behind by ASD epidemiologic and clinical research previously. ASD burden estimates are underestimated as GBD does not account for mortality in ASD.

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Fig. 1: Global burden of Autism-Spectrum Disorder by country or territory, 2019.
Fig. 2: Prevalence trends of Autism-Spectrum Disorder from 1990 to 2019.
Fig. 3: Age patterns of Autism-Spectrum Disorder.

Data availability

Data are publicly available at the Institute for Health Metrics and Evaluation (IHME) website (http://www.ghdx.healthdata.org/gbd-results-tool).

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Authors and Affiliations

Authors

Contributions

All authors contributed and approved the study’s protocol. MS and SC created the first draft of the manuscript. MS, DY and SL analysed data. MS, JS, and SC provided overall guidance. All authors read, edited, and approved the final version of the manuscript.

Corresponding author

Correspondence to Jae Il Shin.

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Competing interests

MS received honoraria/has been consultant for Angelini, Lundbeck. CUC has been a consultant and/or advisor to or has received honoraria from: AbbVie, Acadia, Alkermes, Allergan, Angelini, Aristo, Axsome, Damitsa, Gedeon Richter, Hikma, IntraCellular Therapies, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Medscape, Merck, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Servier, SK Life Science, Sumitomo Dainippon, Sunovion, Supernus, Takeda, Teva, and Viatris. He provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, Rovi, Supernus, and Teva. He has received grant support from Janssen and Takeda. He received royalties from UpToDate and is also a stock option holder of LB Pharma. SC is supported by the following grants from the National Institute for Health and Care Research (NIHR): RP-PG-0618-20003, NIHR128472, NIHR130077, NIHR203035, NIHR203684. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

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We followed the standard procedure recommended to register additional publication from GBD2019 project after publication of capstone paper [18]. Our study was also approved by the Institutional Review Board at Yonsei University Health System for the data use.

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Solmi, M., Song, M., Yon, D.K. et al. Incidence, prevalence, and global burden of autism spectrum disorder from 1990 to 2019 across 204 countries. Mol Psychiatry (2022). https://doi.org/10.1038/s41380-022-01630-7

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