Social determinants of health and Autism Spectrum Disorder

Abstract

Autism Spectrum Disorder (ASD) is one of the most commonly diagnosed neurodevelopmental disorders in Canada, with significant social and economic cost to society. The goal of this dissertation was to systematically examine the impact of social determinants on health of children with ASD. This was achieved through three studies, where the first two were pan-Canadian in scope and the third was a case study in Ontario. The first study examined the prevalence and developmental health of kindergarten children with ASD at the neighbourhood level. The second study examined the relationship between neighbourhood socioeconomic status (SES) and developmental health of children with ASD. Using Ontario as a case study province, the third study examined the relationship between characteristics of primary care providers and children with ASD with their age at diagnosis of this disorder. Each of these studies were conducted as population-based cohort studies where linked health, education, and administrative data were used. Following are the main findings from the three studies: (1) across provinces and territories, the number of children with ASD per neighbourhood ranged from zero to 21; (2) across provinces and territories, there was no consistent association between the size of spatial cluster of children with ASD in neighbourhoods, indicated by the number of children with ASD in a neighbourhood, and their developmental vulnerability; (3) in Ontario, British Columbia, Manitoba, and Newfoundland and Labrador, higher neighbourhood SES was associated with lower likelihood of developmental vulnerability; (4), in Ontario, children with primary care providers with foreign medical training had older age at ASD diagnosis than children with primary care providers with domestic medical training. Across Canada, these findings can help target areas of need and guide the delivery of early intervention services accordingly, whereas in Ontario, they can also help inform ASD related education training for primary care providers.