Race, Income Key Social Determinants Impacting Kids with Autism

Race and income are proving key social determinants of health affecting outcomes for kids with autism, who already have higher-risk health challenges, according to a new report from The Autism Intervention Research Network on Physical Health (AIR-P).

AIR-P, spearheaded by both UCLA Health’s Department of Medicine and the Policy and Analytics Center at Drexel University's A.J. Drexel Autism Institute, suggested that those two SDOH are carving out steep health disparities among children with autism.

Independently, kids with autism who are from low-income families or kids with autism who are BIPOC—Black, Indigenous, or people of color—have poorer health outcomes than their wealthy or White counterparts.

But this latest report also revealed that those two social factors can compound to yield even worse outcomes.

“Discrimination based on race and socioeconomic status is increasingly recognized as an important risk factor to people’s health,” Alice Kuo, MD, PhD, chief of Medicine-Pediatrics at UCLA and project investigator for the federally-funded AIR-P, said in a statement about the report.

“With this report, we can begin to see the devastating combination of autism, poverty and race, an important step in translating the research we do into policy and practice to improve outcomes for people with autism,” Kuo added.

The AIR-P researchers found that over half of children with autism lived in a low-income household, and around a fourth were living in poverty. That’s a higher rate than kids without autism spectrum disorder, the researchers pointed out.

Kids with autism living in low-income households were also more likely to be non-White relative to the general population, the report added.

Moreover, both low-income and non-White children with autism saw worse outcomes than their wealthier and White peers with autism. For example, 76 percent of kids without autism from high-income families reported excellent overall health; only 41 percent of kids with autism from the same income bracket could report the same.

But conversely, kids with autism across all income groups were more likely to report chronic health problems, with a big gap in outcomes opening up among low-income groups. Poor kids with autism were 25 percentage points more likely to have a chronic illness than poor kids without autism; that gulf was only 17 percentage points for kids from the wealthiest families, suggesting that low income is particularly disastrous for families with a child with autism.

And for Black children with autism, those outcomes were even worse. Black children with autism were more likely to experience a number of health conditions, ranging from anxiety to ADHD, than their White peers with autism.

Race and income had a compounding effect on outcomes. Poor and near-poor BIPOC kids with autism were significantly more likely to experience poor overall health compared to their poor or near-poor White counterparts.

These results likely stem from limited access to healthcare and health insurance coverage, the researchers reported. To be clear, kids with autism were overwhelmingly more likely to have a usual source of medical care, to have had a doctor’s visit in the past year, and to access preventive care.

However, these families still reported the most unmet medical needs across all income groups. Importantly, cost-related unmet medical needs were equally as common among wealthy and poor kids with autism, but less common among high-income kids without autism.

Although families of children with autism report having access to healthcare, they face extraordinary costs. About one in five families of kids with autism have out-of-pocket healthcare costs adding up to more than $1,000, compared to only 13 percent of families who do not have a child with autism.

These findings underscore the importance of economic stability for children in promoting health equity. Race and income are key social determinants of health impacting wellness for all children, and particularly those with autism who already face numerous health challenges.

Healthcare policymakers should consider institutional programming tailored to meet the social and economic needs of families with kids with autism.

“Findings like these are important because policymakers, decision-makers and advocates use this information to better understand the needs of the autism population and guide the development of targeted programs and services” Kristy Anderson, PhD, a researcher at the Autism Institute and first author of the report, said in a statement.