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Home / Our research / Determinants of health and inequalities research / Autism / COVID-19 in autistic people

COVID-19 in autistic people

Background

Increasing evidence suggests that autistic people may be at more risk of COVID-19 infection, severity and mortality than the general population. Whilst a few studies have investigated COVID-19 in autistic people, large-scale research is needed for more informative outcomes on risk and risk factors. Our aim was to investigate COVID-19 outcomes and risk factors in autistic people using a whole country population.

What we did

Using data from the British Heart Foundation COVID consortium, spanning the whole population of England, we investigated the prevalence of COVID-19 outcomes of infection, severity and mortality in autistic people and the role of risk factors, such as long-term health conditions, multimorbidity, and use of multiple medicines on COVID-19 outcomes.

What we found

• Autistic adults had increased risk of severe COVID-19, evidenced by higher hospitalisation and mortality rates despite similar vaccination rates. This suggests other factors contribute to this vulnerability.
• Autistic adults had significantly higher rates of morbidity in general, as well as higher rates of complex multimorbidity and polypharmacy than the general population. Risk was particularly high when complex multimorbidity was high, but polypharmacy was low, and vice versa. This suggests that well-managed medication regimens may offer protective effects.
• In particular, mental health conditions were more prevalent in autistic adults. Investigation into different types of medication had differing effects on severe COVID-19, further emphasising the importance of properly prescribed and well-maintained medication regimens.

What these findings mean 

• Despite the younger age and similar vaccination rates of autistic adults, increased risk in hospitalisation and mortality remained. Experiences of health inequalities and systemic barriers in access to care are well documented in autistic people. It is possible that these experiences contribute to the increased risk found in this study.
• The findings of differing morbidity patterns and varying effects of medication type (e.g., antidepressant, antipsychotic, anticholinergic medication) highlight the importance of managing multimorbidity and prescription regimens, particularly in the autistic population. Pandemic response planning policies could be improved by taking into account that autistic adults may require differing prioritisation of vaccination, treatment and healthcare access in the event of future infectious disease outbreaks.

• For Primary Care physicians and specialists (e.g., psychiatrists, GPs): the complexity of multimorbidity and medication effects on infectious disease outcomes may be of particular interest.
• For public health agencies: these findings may be of value to inform pandemic preparedness and more general importance of medication regimens.
• For care coordinators and autistic advocacy groups, these findings may be useful for identifying high-risk patients and informing autistic people of vulnerability.
• For researchers in health inequalities, autism, and epidemiology: this study also identifies further potential points of inequality and the cascading effects on severe health outcomes.

A pre-print version of this paper is currently available here: https://www.medrxiv.org/content/10.1101/2024.02.23.24303274v1 

For further information about this research, please contact Dewy Nijhof.

Page updated 19th May 20225