Importance Family socioeconomic status has been associated with autism spectrum disorder (ASD) diagnoses. Less is known regarding the role of neighborhood disadvantage in the United States, particularly when children have similar access to health insurance. Objective To evaluate the association between neighborhood disadvantage and the diagnosis of ASD and potential effect modification by maternal and child demographic characteristics. Design, Setting, and Participants This cohort study examined a retrospective birth cohort from Kaiser Permanente Southern California (KPSC), an integrated health care system. Children born in 2001 to 2014 at KPSC were followed up through KPSC membership records. Electronic medical records were used to obtain an ASD diagnosis up to December 31, 2019, or the last follow-up. Data were analyzed from February 2022 to September 2023. Exposure Socioeconomic disadvantage at the neighborhood level, an index derived from 7 US census tract characteristics using principal component analysis. Main Outcomes and Measures Clinical ASD diagnosis based on electronic medical records. Associations between neighborhood disadvantage and ASD diagnosis were determined by hazard ratios (HRs) from Cox regression models adjusted for birth year, child sex, maternal age at delivery, parity, severe prepregnancy health conditions, maternal race and ethnicity, and maternal education. Effect modification by maternal race and ethnicity, maternal education, and child sex was assessed. Results Among 318 372 mothers with singleton deliveries during the study period, 6357 children had ASD diagnoses during follow-up; their median age at diagnosis was 3.53 years (IQR, 2.57-5.34 years). Neighborhood disadvantage was associated with a higher likelihood of ASD diagnosis (HR, 1.07; 95% CI, 1.02-1.11, per IQR = 2.70 increase). Children of mothers from minoritized racial and ethnic groups (African American or Black, Asian or Pacific Islander, Hispanic or Latinx groups) had increased likelihood of ASD diagnosis compared with children of White mothers. There was an interaction between maternal race and ethnicity and neighborhood disadvantage (difference in log-likelihood = 21.88; P < .001 for interaction under χ24); neighborhood disadvantage was only associated with ASD among children of White mothers (HR, 1.17; 95% CI, 1.09-1.26, per IQR = 2.00 increase). Maternal education and child sex did not significantly modify the neighborhood-ASD association. Conclusions and Relevance In this study, children residing in more disadvantaged neighborhoods at birth had higher likelihood of ASD diagnosis among a population with health insurance. Future research is warranted to investigate the mechanisms behind the neighborhood-related disparities in ASD diagnosis, alongside efforts to provide resources for early intervention and family support in communities with a higher likelihood of ASD.

中文翻译：

---

拥有健康保险的人群中的邻里劣势和自闭症谱系障碍。

重要性 家庭社会经济地位与自闭症谱系障碍 (ASD) 的诊断有关。人们对美国邻里劣势的影响知之甚少，特别是当儿童有类似的医疗保险机会时。目的 评估邻里劣势与 ASD 诊断之间的关联以及母婴人口特征的潜在影响修正。设计、设置和参与者 这项队列研究考察了南加州凯撒医疗机构 (KPSC)（一个综合医疗保健系统）的回顾性出生队列。通过 KPSC 会员记录对 2001 年至 2014 年在 KPSC 出生的儿童进行追踪。使用电子病历获取截至 2019 年 12 月 31 日或最后一次随访的 ASD 诊断。对 2022 年 2 月至 2023 年 9 月的数据进行了分析。暴露社区层面的社会经济劣势，该指数使用主成分分析根据美国 7 个人口普查区的特征得出。主要成果和措施 基于电子病历的 ASD 临床诊断。邻里劣势与 ASD 诊断之间的关联是通过 Cox 回归模型的风险比 (HR) 确定的，该模型根据出生年份、儿童性别、母亲分娩年龄、胎次、严重的孕前健康状况、母亲的种族和民族以及母亲的教育程度进行了调整。评估了母亲种族和族裔、母亲教育程度和儿童性别对影响的影响。结果 在研究期间的 318 372 名单胎分娩母亲中，6 357 名儿童在随访期间被诊断为 ASD；他们诊断时的中位年龄为 3.53 岁（IQR，2.57-5.34 岁）。社区劣势与 ASD 诊断的可能性较高相关（HR，1.07；95% CI，1.02-1.11，每 IQR = 2.70 增加）。与白人母亲的孩子相比，少数种族和族裔群体（非裔美国人或黑人、亚裔或太平洋岛民、西班牙裔或拉丁裔群体）母亲的孩子患自闭症谱系障碍的可能性更高。母亲种族、种族和邻里劣势之间存在交互作用（对数似然差异 = 21.88；χ24 下交互作用的 P < .001）；邻里劣势仅与白人母亲的孩子的 ASD 相关（HR，1.17；95% CI，1.09-1.26，每 IQR = 2.00 增加）。母亲教育和儿童性别并没有显着改变邻里与自闭症谱系障碍的关联。结论和相关性 在这项研究中，在有健康保险的人群中，出生时居住在较弱势社区的儿童诊断自闭症谱系障碍的可能性更高。未来的研究有必要调查 ASD 诊断中与邻里相关的差异背后的机制，同时努力为 ASD 可能性较高的社区的早期干预和家庭支持提供资源。