Abstract
Background: The risk of premature mortality is significantly higher among individuals with ASD, compared with the general population. However, there are no previous studies examining inpatient hospital mortality among adults with ASD using a large nationally representative database. Research Objective: To examine inpatient hospital mortality among adults with ASD in comparison with the general hospital population, and investigate the moderating role of gender. Study Design: Data from the 2004-2014 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample was used. We modeled logistic regressions to assess all-cause and cause-specific inpatient hospital mortality. Population Studied: ASD hospitalizations (n=34,267) were identified using ICD-9-CM codes. Non-ASD hospitalizations (n=102,801) were age-matched and sex-matched in a 1:3 ratio to cases. Principal Findings: Adults with ASD had higher inpatient hospital mortality than adults without ASD (OR=1.7, 95%CI:1.3-2.1). This risk remained high even after adjustment for age, gender, race/ethnicity, median household income for patient’s zip code, comorbidity, hospital region, and hospitalization year (OR=1.4, 95%CI:1.1-1.9). Cause-specific analyses indicated elevated inpatient hospital mortality in adults with ASD for infectious and parasitic diseases (OR=1.4, 95%CI:1.1-1.9), diseases of the nervous system and sense organs (OR=2.7, 95%CI:1.5-4.9), diseases of the respiratory system (OR=2.0, 95%CI:1.5-2.6), and diseases of the digestive system (OR=3.2, 95%CI:2.0-5.4). Inpatient hospital mortality was moderated by gender. Conclusions: Inpatient hospital mortality among adults with ASD is markedly elevated in comparison with the general hospital population. Implications for Policy or Practice: ASD-related mortality differences suggest the need to improve access to, and quality of preventive, primary and hospital care among people with ASD.