Autism Spectrum Disorders in China: An Analysis of Temporal Trends in Prevalence, Incidence, and DALYs (1990-2021) Based on GBD 2021 Data.

This study looked at autism rates in China from 1990 to 2021 and made predictions until 2036. Autism rates increased slightly each year, mainly because China's population grew rather than autism becoming more common. Young children (0-5 years) had the highest rates. Boys are expected to have increasing rates while girls may have decreasing rates. The findings suggest China needs better early detection programs and support that considers gender differences.

This comprehensive epidemiological study analyzed autism spectrum disorder (ASD) trends in China from 1990-2021 using Global Burden of Disease data and projected burden to 2036. Key findings showed prevalence increased by 0.22% annually, while incidence remained relatively stable (-0.07% annually). ASD burden was highest in children aged 0-5 years and declined after age 60. Population growth accounted for 89.7% of rising prevalence, with epidemiological changes contributing 32.6%.

Males showed increasing prevalence trends while females showed decreasing trends in projections. The study highlights the growing ASD burden in China driven primarily by demographic changes rather than true incidence increases, emphasizing the need for early detection and gender-sensitive interventions.

Findings support prioritizing early detection programs for children under 5 years and developing gender-sensitive interventions. Healthcare planning should focus on demographic-driven service expansion rather than assuming epidemic increases. Resource allocation should target young children while maintaining awareness of potential underdiagnosis in females.

Study relies on secondary GBD data which may have inherent limitations in autism case identification and reporting. Projections based on historical trends may not account for future changes in diagnostic practices or awareness. Gender trend differences require further investigation to understand underlying mechanisms.

To examine the temporal trends in the prevalence, incidence, and disability-adjusted life years (DALYs) of autism spectrum disorder (ASD) in China from 1990 to 2021 and to project the future burden to 2036. Data were sourced from the Global Burden of Disease (GBD) 2021 provided by the Institute for Health Metrics and Evaluation (IHME). Join-point regression was applied to estimate the annual percentage change (APC) of prevalence, incidence, and DALYs. Age-period-cohort analysis was used to assess the effects of age, period, and cohort.

Decomposition analysis quantified the contributions of population growth, demographic aging, and epidemiological changes. An AutoRegressive Integrated Moving Average (ARIMA) model was employed for projections to 2036. Between 1990 and 2021, the average annual percentage change (AAPC) was 0.22% (95% uncertainty interval [UI]: 0.20%-0.24%) for prevalence, -0.07% (95% UI: -0.14%-0.28%) for incidence, and 0.23% (95% UI: 0.21%-0.25%) for DALYs. ASD prevalence and DALYs peaked in children aged 0-5 years and declined after age 60.

Rising prevalence and DALYs were mainly attributable to population growth (89.7% and 95.2%) and epidemiological changes (32.6% and 36.2%), while aging offset growth (-22.4% and -16.0%). Projections indicated stable age-standardized incidence for both sexes but divergent prevalence trends, with rates increasing among males and decreasing among females. The ASD burden in China is rising, largely driven by demographic and epidemiological dynamics, with young children and males being the most affected groups. Prioritizing early detection and gender-sensitive interventions are recommended.