Short Report: Prevalence of Autism Spectrum Disorder in a Large Pediatric Primary Care Network

Historically, children from non-Hispanic Black and Hispanic backgrounds, those from lower-income families, and girls are less likely to be diagnosed with autism spectrum disorder (ASD). Under-identification among these historically and contemporaneously marginalized groups can limit their access to early, ASD-specific interventions, which can have long-term negative impacts. Recent data suggest that some of these trends may be narrowing, or even reversing. Using electronic health record data, we calculated ASD prevalence rates and age of first documented diagnosis across socio-demographic groups. Our cohort included children seen at young ages (when eligible for screening in early childhood) and again at least after age 4 years in a large primary care network. We found that ASD prevalence was unexpectedly higher among Asian children, non-Hispanic Black children, children with higher Social Vulnerability Index scores (a measure of socio-economic risk at the neighborhood level), and children who received care in urban primary care sites. We did not find differences in the age at which ASD diagnoses were documented in children’s records across these groups. Receiving primary care at an urban site (regardless of location of specialty care) appeared to account for most other socio-demographic differences in ASD prevalence rates, except among Asian children, who remained more likely to be diagnosed with ASD after controlling for other factors. We must continue to better understand the process by which children with ASD from traditionally under-identified and under-served backgrounds come to be recognized, to continue to improve the equity of care.