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Premature mortality in autism spectrum disorder

  • Tatja Hirvikoski (a1), Ellenor Mittendorfer-Rutz (a2), Marcus Boman (a3), Henrik Larsson (a3), Paul Lichtenstein (a3) and Sven Bölte (a4)...

Mortality has been suggested to be increased in autism spectrum disorder (ASD).


To examine both all-cause and cause-specific mortality in ASD, as well as investigate moderating role of gender and intellectual ability.


Odds ratios (ORs) were calculated for a population-based cohort of ASD probands (n = 27 122, diagnosed between 1987 and 2009) compared with gender-, age- and county of residence-matched controls (n = 2 672 185).


During the observed period, 24 358 (0.91%) individuals in the general population died, whereas the corresponding figure for individuals with ASD was 706 (2.60%; OR = 2.56; 95% CI 2.38–2.76). Cause-specific analyses showed elevated mortality in ASD for almost all analysed diagnostic categories. Mortality and patterns for cause-specific mortality were partly moderated by gender and general intellectual ability.


Premature mortality was markedly increased in ASD owing to a multitude of medical conditions.

Corresponding author
Tatja Hirvikoski, PhD/Neuropsychologist, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), CAP Research Center, Gävlegatan 22B, SE-11330 Stockholm, Sweden. Email:
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The study was funded by the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet (grants no. 20120419 and 20130630, Tatja Hirvikoski), Karolinska Institutet in cooperation with the Stockholm County Council (KI/SLL, 2008:9, Sven Bölte), the Swedish Research Council (grant no. 523-2009-7054, Sven Bölte) and the Swedish Research Council in cooperation with the Swedish Research Council for Health, Working Life and Welfare, Vinnova and FORMAS (cross-disciplinary research programme concerning children's and youth's mental health, grant no. 259-2012-24, Sven Bölte).

Declaration of interest


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1 Billstedt, E, Gillberg, IC, Gillberg, C. Autism after adolescence: population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood. J Autism Dev Disord 2005; 35: 351–60.
2 Howlin, P, Moss, P, Savage, S, Rutter, M. Social outcomes in mid- to later adulthood among individuals diagnosed with autism and average nonverbal IQ as children. J Am Acad Child Adolesc Psychiatry 2013; 52: 572–81.
3 Pinborough-Zimmerman, J, Bakian, AV, Fombonne, E, Bilder, D, Taylor, J, McMahon, WM. Changes in the administrative prevalence of autism spectrum disorders: contribution of special education and health from 2002–2008. J Autism Dev Disord 2012; 42: 521–30.
4 Wazana, A, Bresnahan, M, Kline, J. The autism epidemic: fact or artifact? J Am Acad Child Adolesc Psychiatry 2007; 46: 721–30.
5 Cederlund, M, Hagberg, B, Billstedt, E, Gillberg, IC, Gillberg, C. Asperger syndrome and autism: a comparative longitudinal follow-up study more than 5 years after original diagnosis. J Autism Dev Disord 2008; 38: 7285.
6 Howlin, P, Goode, S, Hutton, J, Rutter, M. Adult outcome for children with autism. J Child Psychol Psychiatry 2004; 45: 212–29.
7 Gillberg, C, Steffenburg, S. Outcome and prognostic factors in infantile autism and similar conditions: a population-based study of 46 cases followed through puberty. J Autism Dev Disord 1987; 17: 273–87.
8 Bölte, S, de Schipper, E, Robison, JE, Wong, VC, Selb, M, Singhal, N, et al. Classification of functioning and impairment: the development of ICF core sets for autism spectrum disorder. Autism Res 2014; 7: 167–72.
9 Caamano, M, Boada, L, Merchan-Naranjo, J, Moreno, C, Llorente, C, Moreno, D, et al. Psychopathology in children and adolescents with ASD without mental retardation. J Autism Dev Disord 2013; 43: 2442–9.
10 Hofvander, B, Delorme, R, Chaste, P, Nyden, A, Wentz, E, Stahlberg, O, et al. Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry 2009; 9: 35.
11 Lichtenstein, P, Carlstrom, E, Rastam, M, Gillberg, C, Anckarsater, H. The genetics of autism spectrum disorders and related neuropsychiatric disorders in childhood. Am J Psychiatry 2010; 167: 1357–63.
12 Lugnegard, T, Hallerback, MU, Gillberg, C. Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Res Dev Disabil 2011; 32: 1910–7.
13 Skokauskas, N, Gallagher, L. Psychosis, affective disorders and anxiety in autistic spectrum disorder: prevalence and nosological considerations. Psychopathology 2010; 43: 816.
14 Persico, AM, Napolioni, V. Autism genetics. Behav Brain Res 2013; 251: 95112.
15 Gillberg, C, Billstedt, E, Sundh, V, Gillberg, IC. Mortality in autism: a prospective longitudinal community-based study. J Autism Dev Disord 2010; 40: 352–7.
16 Isager, T, Mouridsen, SE, Rich, B. Mortality and causes of death in pervasive developmental disorders. Autism 1999; 3: 716.
17 Mouridsen, SE, Bronnum-Hansen, H, Rich, B, Isager, T. Mortality and causes of death in autism spectrum disorders: an update. Autism 2008; 12: 403–14.
18 Pickett, JA, Paculdo, DR, Shavelle, RM, Strauss, DJ. 1998–2002 update on Causes of death in autism. J Autism Dev Disord 2006; 36: 287–8.
19 Shavelle, RM, Strauss, DJ, Pickett, J. Causes of death in autism. J Autism Dev Disord 2001; 31: 569–76.
20 Bilder, D, Botts, EL, Smith, KR, Pimentel, R, Farley, M, Viskochil, J, et al. Excess mortality and causes of death in autism spectrum disorders: a follow up of the 1980s Utah/UCLA autism epidemiologic study. J Autism Dev Disord 2013; 43: 1196–204.
21 Woolfenden, S, Sarkozy, V, Ridley, G, Coory, M, Williams, K. A systematic review of two outcomes in autism spectrum disorder – epilepsy and mortality. Dev Med Child Neurol 2012; 54: 306–12.
22 Idring, S, Rai, D, Dal, H, Dalman, C, Sturm, H, Zander, E, et al. Autism spectrum disorders in the Stockholm Youth Cohort: design, prevalence and validity. PLoS ONE 2012; 7: e41280.
23 World Health Organization. ICD-9: International Statistical Classification of Diseases and Related Health Problems. WHO, 1978.
24 World Health Organization. ICD-10: The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
25 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edn (DSM-5). APA, 2013.
26 Idring, S, Magnusson, C, Lundberg, M, Ek, M, Rai, D, Svensson, AC, et al. Parental age and the risk of autism spectrum disorders: findings from a Swedish population-based cohort. Int J Epidemiol 2014; 43: 107–15.
27 Magnusson, C, Rai, D, Goodman, A, Lundberg, M, Idring, S, Svensson, A, et al. Migration and autism spectrum disorder: population-based study. Br J Psychiatry 2012; 201: 109–15.
28 Lager, A, Berlin, M, Heimerson, I, Danielsson, M. Young people's health: Health in Sweden: The National Public Health Report 2012. Chapter 3. Scand J Public Health 2012; 40: 4271.
29 Mittendorfer-Rutz, E, Rasmussen, F, Wasserman, D. Restricted fetal growth and adverse maternal psychosocial and socioeconomic conditions as risk factors for suicidal behaviour of offspring: a cohort study. Lancet 2004; 364: 1135–40.
30 Baxter, AJ, Brugha, TS, Erskine, HE, Scheurer, RW, Vos, T, Scott, JG. The epidemiology and global burden of autism spectrum disorders. In Psychol Med 2014: 11: 113.
31 Cassidy, S, Bradley, P, Robinson, J, Allison, C, McHugh, M, Baron-Cohen, S. Suicidal ideation and suicide plans or attempts in adults with Asperger's syndrome attending a specialist diagnostic clinic: a clinical cohort study. Lancet Psychiatry 2014; 1: 142–7.
32 Fowler, JC. Suicide risk assessment in clinical practice: pragmatic guidelines for imperfect assessments. Psychotherapy 2012; 49: 8190.
33 Oquendo, MA, Dragatsi, D, Harkavy-Friedman, J, Dervic, K, Currier, D, Burke, AK, et al. Protective factors against suicidal behavior in Latinos. J Nerv Ment Dis 2005; 193: 438–43.
34 Chioqueta, AP, Stiles, TC. The relationship between psychological buffers, hopelessness, and suicidal ideation: identification of protective factors. Crisis 2007; 28: 6773.
35 Bjorkenstam, E, Ljung, R, Burstrom, B, Mittendorfer-Rutz, E, Hallqvist, J, Weitoft, GR. Quality of medical care and excess mortality in psychiatric patients – a nationwide register-based study in Sweden. BMJ Open 2012; 2: e000778.
36 Rutstein, DD, Berenberg, W, Chalmers, TC, Child, CG III, Fishman, AP, Perrin, EB. Measuring the quality of medical care. A clinical method. N Engl J Med 1976; 294: 582–8.
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Premature mortality in autism spectrum disorder

  • Tatja Hirvikoski (a1), Ellenor Mittendorfer-Rutz (a2), Marcus Boman (a3), Henrik Larsson (a3), Paul Lichtenstein (a3) and Sven Bölte (a4)...
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