Recent policy campaign Personal tragedies, public crisis led by Autistica, the UK’s leading autism medical research charity, emphasises that investigating rates and causes of premature mortality in autistic people is of paramount importance. Poor physical health may be an important risk factor in premature mortality in this population, but we still know very little about this area of research. In the systematic review recently published by the Scottish Learning Disabilities Observatory and published in BJPsych’s themed issue on neurodevelopmental conditions, we have summarised what is known so far. We have found 24 relevant reviews with studies on autistic children and adults, which showed that conditions such as sleep problems, epilepsy, sensory impairments, atopy (allergic diseases), autoimmune disorders, incontinence and obesity are more common in people with autism than in the general population. Evidence on other health problems such as dental caries is too inconsistent to draw any firm conclusions. There are also substantial gaps in this area of research, as some health problems, particularly cardiovascular conditions and cancers, are underexplored in the autistic population despite being the leading causes of death in the general population.

This relatively limited body of research shows that the importance of investigating physical health in autistic people is still not widely recognised in the field despite existing evidence pointing to heightened risk of premature mortality in this population. The largest study to date has shown that autistic people with co-occurring intellectual disabilities experience elevated mortality for most of the specific causes of death, with the most common cause being epilepsy, suggesting that the excess mortality in this group may be related to the presence of co-occurring medical conditions. In the same study, in the autism group without co-occurring intellectual disabilities, suicide risk was also significantly elevated, but both people with autism with and without intellectual disabilities were at an increased risk of suicide, suggesting that having intellectual disabilities may not explain the higher risk of suicide deaths in this population.

Thus, it remains largely unknown whether or not the presence of intellectual disability represents an additional risk factor for premature mortality over and above the presence of autism alone and what role having poor physical health may play in this correlation, suggesting that there may be a need for better recognition and management of differing health needs of people with autism with and without co-occurring intellectual disabilities.

To summarise, we have to learn more about physical health of people with autism, and particularly about those conditions, which are the leading causes of death in the wider population in order to establish a much-needed evidence base for future intervention development and reduction of the risk of premature mortality in autistic people through better management of intellectual disabilities and prevention of other long-term health conditions. The latter, in turn, has the potential to reduce health inequalities experienced by autistic people and deliver large cost savings to healthcare commissioners and providers.

Related article: Umbrella systematic review on comorbid physical conditions in people with autism Ewelina Rydzewska, Kirsty Dunn and Sally-Ann Cooper

View the themed issue: Neurodevelopmental Conditions

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