Early diagnosis of autism and other developmental disorders, Brazil, 2013–2019

Girianelli, Vania Reis; Tomazelli, Jeane; Silva, Cosme Marcelo Furtado Passos da; Fernandes, Conceição Santos

doi:10.11606/s1518-8787.2023057004710

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Sumário

Original Article • Rev. Saúde Pública 57 • 2023 • https://doi.org/10.11606/s1518-8787.2023057004710 copy

Early diagnosis of autism and other developmental disorders, Brazil, 2013–2019

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To investigate the factors associated with the early diagnosis of autism and other types of pervasive developmental disorder (PDD) in children treated at the Psychosocial Care Center for Children and Adolescents of the Unified Health System, from 2013 to 2019,in Brazil.

METHODS

An exploratory cross-sectional study, based on data from the Record of Outpatient Health Actions (RAAS) of the first appointment of children aged 1 to 12 years. The gross (RR_g) and adjusted (RR_a) relative risks and respective 95% confidence intervals (95%CI) were estimated using the Poisson regression model with robust variance estimation.

RESULTS

Of the 22,483 children included in the study, the majority were male (81.9%), lived in the same municipality where they were diagnosed (96.8%) and in the Southeast region (57.7%). Early diagnosis was higher for childhood autism (RR_g = 1.48; 95%CI 1.27–1.71) , PDD without subtype designation (RR_g = 1.55; 95%CI 1.34–1.80), other PDD (RR_g = 1.48; 95%CI 1.21–1.81) and PDD not otherwise specified (RR_g = 1.44; 95%CI 1.22–1.69) than for atypical autism. Children residing in the same municipality where the diagnosis was made had a higher rate of early diagnosis (RR_g = 1.31; 95%CI 1.10–1.55) than the others; as well as those referred by primary care (RR_g = 1.51; 95%CI 1.37–1.68) and by spontaneous demand (RR_g = 1.45; 95%CI 1.31–1.61) than those from other types of referral. Early diagnosis was higher from 2014 and lower in the North region than in the other regions. In the multiple analysis, the magnitude of RR_a was similar to that of RR_g.

CONCLUSIONS

Early identification of autism and other PDD has improved in Brazil, but it still represents about 30% of the diagnoses made. The variables included in the model were significant, but still explain little of the early diagnosis of children with autism and other PDD.

Autism Spectrum Disorder; Epidemiology; Child Development Disorders, Pervasive; Early Diagnosis; Analytical Epidemiology; Psychosocial Support Systems; Unified Health System

Characteristics	Total		Diagnosis

			Early		Late		p^b

	n	%	n	%	n	%
Sex
Female	4,075	18.1	1,221	17.9	2,854	18.2	0.502
Male	18,408	81.9	5,614	82.1	12,794	81.8	0.502
Race/color
White	5,835	26.0	1,880	27.5	3,955	25.3	< 0.001
Black	461	2.1	107	1.6	354	2.3
Brown	6,638	29.5	2,032	29.7	4,606	29.4
Yellow	710	3.2	111	1.6	599	3.8
Indigenous	5	0.0	2	0.0	3	0.0	-
Unknown	8,834	39.3	2,703	39.5	6,131	39.2	-
Origin
Spontaneous demand	11,468	51.0	3,483	51.0	7,985	51.0	< 0.001
Primary care	9,719	43.2	3,081	45.1	6,638	42.4
Other^a	1,296	5.8	271	4.0	1,025	6.6
Region of residence
North	1,358	6.0	248	3.6	1,110	7.1	< 0.001
Northeast	5,495	24.4	1,867	27.3	3,628	23.2
Midwest	897	4.0	249	3.6	648	4.1
Southeast	12,969	57.7	4,053	59.3	8,916	57.0
South	1,764	7.8	418	6.1	1,346	8.6
Municipality of residence the same as municipality of diagnosis
Yes	21,773	96.8	6,656	97.4	15,117	96.6	0.002
No	710	3.2	179	2.6	531	3.4	0.002
Initial diagnosis (ICD)
General PDD (F84)	12,670	56.4	3,978	58.2	8,692	55.5	< 0.001
Childhood autism (F84.0)	7,177	31.9	2,143	31.4	5,034	32.2
Atypical Autism (F84.1)	628	2.8	127	1.9	501	3.2
Other PDD (F84.8)	445	2.0	133	1.9	312	2.0
PDD not otherwise specified (F84.9)	1,563	7.0	454	6.6	1,109	7.1
Year of diagnosis
2013	4,242	18.9	989	14.5	3,253	20.8	< 0.001
2014	2,490	11.1	723	10.6	1,767	11.3
2015	2,669	11.9	782	11.4	1,887	12.1
2016	2,932	13.0	914	13.4	2,018	12.9
2017	3,529	15.7	1,179	17.2	2,350	15.0
2018	3,645	16.2	1,271	18.6	2,374	15.2
2019	2,976	13.2	977	14.3	1,999	12.8
Municipal HDI
Very low	761	3.4	232	3.4	529	3.4	0.008
Low	4,378	19.5	1,424	20.8	2,954	18.9
Moderate	9,923	44.1	2,970	43.5	6,953	44.4
High	7,421	33.0	2,209	32.3	5,212	33.3

Region of residence	Diagnosis	n	%	Age of child (years)

				Mean	Standard deviation	Median	1st Quartile	3rd Quartile	Min.	Max.
North	Atypical autism	13	1.0	7.3	2.0	6.0	6.0	9.0	5	11
	Childhood autism	322	23.7	6.3	2.7	6.0	4.0	8.0	1	12
	General PDD	993	73.1	6.1	2.8	6.0	4.0	8.0	1	12
	Other PDD	2	0.1	4.5	0.7	4.5	4.3	4.8	4	5
	PDD not otherwise specified	28	2.1	5.8	2.7	5.5	3.8	7.0	2	12
	Subtotal	1,358	100.0	6.2	2.7	6.0	4.0	8.0	1	12
Northeast	Atypical autism	203	3.7	5.9	2.8	5.0	4.0	7.5	1	12
	Childhood autism	2,144	39.0	5.0	2.7	4.0	3.0	7.0	1	12
	General PDD	2,798	50.9	5.2	2.8	5.0	3.0	7.0	1	12
	Other PDD	133	2.4	5.3	2.9	5.0	3.0	7.0	1	12
	PDD not otherwise specified	217	3.9	5.4	2.6	5.0	3.0	7.0	1	12
	Subtotal	5,495	100.0	5.2	2.8	4.0	3.0	7.0	1	12
Midwest	Atypical autism	36	4.0	6.3	2.8	5.5	4.0	9.0	2	12
	Childhood autism	235	26.2	5.6	2.8	5.0	3.0	8.0	1	12
	General PDD	590	65.8	5.7	2.9	5.0	3.0	8.0	1	12
	Other PDD	6	0.7	6.7	4.3	5.0	3.3	10.5	3	12
	PDD not otherwise specified	30	3.3	5.9	2.9	6.0	4.0	8.0	1	12
	Subtotal	897	100.0	5.7	2.8	5.0	3.0	8.0	1	12
Southeast	Atypical autism	308	2.4	6.3	3.0	6.0	4.0	9.0	1	12
	Childhood autism	3,815	29.4	5.5	2.8	5.0	3.0	7.0	1	12
	General PDD	7,646	59.0	5.4	2.9	5.0	3.0	7.0	1	12
	Other PDD	220	1.7	6.0	3.1	6.0	3.0	8.0	1	12
	PDD not otherwise specified	980	7.6	5.6	2.9	5.0	3.0	7.0	1	12
	Subtotal	12,969	100.0	5.5	2.9	5.0	3.0	7.0	1	12
South	Atypical autism	68	3.9	6.2	3.0	6.0	4.0	9.0	1	12
	Childhood autism	661	37.5	6.3	2.9	6.0	4.0	8.0	1	12
	General PDD	643	36.5	6.1	3.1	6.0	4.0	8.0	1	12
	Other PDD	84	4.8	5.8	2.9	5.0	4.0	8.0	1	12
	PDD not otherwise specified	308	17.5	5.6	3.1	5.0	3.0	8.0	1	12
	Subtotal	1,764	100.0	6.1	3.0	6.0	4.0	8.0	1	12
Brazil	Atypical autism	628	2.8	6.2	2.9	6.0	4.0	9.0	1	12
	Childhood autism	7,177	31.9	5.5	2.8	5.0	3.0	7.0	1	12
	General PDD	12,670	56.4	5.4	2.9	5.0	3.0	7.0	1	12
	Other PDD	445	2.0	5.8	3.0	5.0	3.0	8.0	1	12
	PDD not otherwise specified	1,563	7.0	5.6	2.9	5.0	3.0	7.0	1	12
	Subtotal	22,483	100.0	5.5	2.9	5.0	3.0	7.0	1	12

Variables	RRg	95%CI	RRa	95%CI
Initial diagnosis
Atypical autism	1.00		1.00	-
Childhood autism	1.48	1.27–1.71	1.43	1.23–1.66
General PDD	1.55	1.34–1.80	1.50	1.29–1.74
Other PDD	1.48	1.21–1.81	1.49	1.21–1.83
PDD not otherwise specified	1.44	1.22–1.69	1.49	1.26–1.76
Origin
Other^a	1.00		1.00
Primary care	1.51	1.37–1.68	1.40	1.26–1.55
Spontaneous demand	1.45	1.31–1.61	1.29	1.16–1.43
Year of diagnosis
2013	1.00	-	1.00	-
2014	1.25	1.15–1.35	1.25	1.15–1.35
2015	1.26	1.16–1.36	1.24	1.15–1.35
2016	1.34	1.24–1.44	1.33	1.23–1.44
2017	1.43	1.34–1.54	1.41	1.37–1.58
2018	1.50	1.40–1.60	1.47	1.37–1.58
2019	1.40	1.31–1.52	1.40	1.30–1.50
Region of residence
North	1.00	-	1.00	-
Northeast	1.86	1.67–2.08	1.90	1.70–2.13
Midwest	1.52	1.31–1.76	1.51	1.31–1.76
Southeast	1.71	1.54–1.90	1.69	1.52–1.88
South	1.29	1.14– 1.48	1.27	1.11– 1.45
Municipality of residence the same as municipality of diagnosis
No	1.00	-	1.00
Yes	1.31	1.10–1.55	1.27	1.11–1.42
Municipal HDI^b
Very low	1.00	-
Low	1.07	0.95–1.20
Moderate	0.98	0.88–1.10
High	0.98	0.87–1.09
Sex
Female	1.00	-
Male	1.02	0.97–1.07

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[1] Correspondence: Vania Reis Girianelli Fundação Oswaldo Cruz Escola Nacional de Saúde Pública Sérgio Arouca Departamento de Direitos Humanos, Saúde e Diversidade Cultural Ave. Brasil, 4036 - 905, Manguinhos 21040-361 Rio de Janeiro, RJ, Brasil E-mail: vaniagirianelli@yahoo.com.br