Available online 23 April 2023

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The Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) tracks autism spectrum disorder (ASD) in selected counties within Georgia as part of the Autism and Developmental Disabilities Monitoring Network. ADDM Network analyses have historically found higher prevalence of ASD in areas of higher socioeconomic status. Methods: We linked 2018 data from CDC’s Social Vulnerability Index (SVI) to two MADDSP counties by census tract, grouped census tracts into tertiles representing low, medium, and high social vulnerability, and calculated ASD prevalence for each tertile, overall and by each of four SVI themes. Results: We found that overall prevalence was higher in areas of low compared to high vulnerability for the socioeconomic status and transportation themes, and in areas of medium compared to high vulnerability for all themes. This pattern was consistent among males but varied for females and by race/ethnicity. Conclusion: Linking ASD prevalence to SVI metrics can improve understanding of inequities among children with ASD in racial and ethnic minority groups or those living in low resource settings. These methods can be applied to other ADDM Network surveillance sites and public health surveillance programs.

Section snippetsPurpose

Autism spectrum disorder (ASD) is a developmental disability characterized by the occurrence of persistent impairments in social interaction and the presence of restricted, repetitive patterns of behaviors, interests, or activities [1]. The Autism and Developmental Disabilities Monitoring (ADDM) Network is a population-based surveillance system that estimates the prevalence of ASD and other developmental disabilities among children in selected communities throughout the U.S. [2] ADDM is modeled

Methods

MADDSP conducts surveillance for 8-year-old children with ASD every two years. To identify children, staff request records from educational sources for children who receive special education services and from medical sources that evaluate and treat children with developmental disabilities based on select International Classification of Diseases, Ninth Revision (ICD-9) or International Classification of Diseases, Tenth Revision (ICD-10) codes for developmental disabilities. MADDSP staff then

Results

We identified 458 8-year-old children in 2018 who met the case definition for ASD. Eighty-three percent of children were male; 43% of children were Black, 28% White, 14% Hispanic, 7% Asian, and 8% other or unknown race/ethnicity (Supplemental Table). The population of 8-year-old children in the surveillance area was 23,136 yielding an overall ASD prevalence of 19.8 per 1,000 children.

ASD prevalence varied across SVI themes (Table 1). Prevalence was higher in areas of low

Conclusions

Disparities in the prevalence of ASD by race/ethnicity and SES have been frequently observed. These longstanding disparities appear to be changing, and more comprehensive measures can help understand these changes. The SVI includes more encompassing measures than the SES indicators used in previous ADDM analyses. Using these SVI indicators, we found that ASD prevalence was generally higher in areas of low or medium vulnerability compared to areas of high vulnerability. However, the opposite

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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