The poorer physical health of autistic adults compared to non-autistic adults has been highlighted by several epidemiological studies. However, research has so far been limited to specific geographical areas and has primarily focused on young autistic individuals (aged 35 years and younger). Recent studies indicate a higher rate of mortality in autistic people, as well as poorer quality of self-reported healthcare interactions. This study aims to determine, first, whether autistic people experience greater levels of non-communicable health conditions and second, whether these are explained by differences in demographics (i.e. sex, country of residence, ethnicity, education level), alcohol use, smoking, body mass index (BMI), or family history of medical conditions. We employed a cross-sectional, convenience-sampling study via an anonymous, online survey of autistic and non-autistic adults (n = 2305, mean age = 41.6, 65.9% female, 49% autistic). The survey asked participants to self-report information about their demographics, autism diagnosis, diet, exercise, sleep, sexual health, substance use, personal medical history, and family medical history (for all first-degree, biological relatives). Binomial logistic regression across four iterative models of increasing complexity was applied to assess rates of physical health conditions. The Benjamini–Hochberg correction was used to account for multiple testing, and only physical health conditions that achieved at least 1% endorsement within the overall sample (n > 22) were included in the analysis to reduce risk of Type I errors. We also used novel network analysis methods to test whether there are increased levels of multimorbidity between autistic and non-autistic people. There were significantly elevated rates of non-communicable conditions across all organ systems in autistic people, including gastrointestinal, neurological, endocrine, visual, ear/nose/throat, skin, liver and kidney, and haematological conditions. We confirmed previous findings by showing highly significant differences in rates of neurological and gastrointestinal symptoms (p < 0.0001). In addition, we established in the largest sample to date that Ehler-Danlos Syndrome (EDS) was more likely to occur among autistic females compared to non-autistic females. Finally, we found a higher prevalence of Coeliac’s disease among autistic individuals compared to non-autistic individuals after controlling for sex, ethnicity, country of residence, alcohol use, smoking, and BMI, but these results became non-significant after accounting for family history. Our study is biased towards females, white individuals, highly educated people, and UK residents, likely due to sampling biases. Our self-report study design may also exclude those who lack access to computers, or those with intellectual disability. Our network analysis is also limited in size. This study provides evidence of widespread, physical health comorbidity that spans nearly all major organ systems in autistic adults compared to non-autistic adults, using both binary logistic regression and network models. Healthcare professionals must be made aware of the range of co-occurring physical health conditions that may be more common among autistic people. However, our findings also point towards potential avenues requiring further exploration, such as the association of autism with both Coeliac’s disease and EDS.

中文翻译：

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自闭症青少年和成人所有器官系统慢性身体健康状况的发生率增加

多项流行病学研究强调，与非自闭症成人相比，自闭症成人的身体健康状况较差。然而，迄今为止的研究仅限于特定地理区域，并且主要集中于年轻的自闭症患者（35 岁及以下）。最近的研究表明，自闭症患者的死亡率较高，而且自我报告的医疗互动质量较差。这项研究的目的首先是确定自闭症患者是否会经历更严重的非传染性健康状况，其次是确定这些症状是否可以通过人口统计数据（即性别、居住国、种族、教育水平）、饮酒、吸烟、吸烟等方面的差异来解释。体重指数 (BMI) 或家族病史。我们通过对自闭症和非自闭症成年人（n = 2305，平均年龄 = 41.6，65.9% 女性，49% 自闭症患者）进行匿名在线调查，进行了横断面方便抽样研究。该调查要求参与者自我报告有关人口统计、自闭症诊断、饮食、运动、睡眠、性健康、药物使用、个人病史和家族病史（针对所有一级亲生亲属）的信息。应用四个复杂性不断增加的迭代模型的二项式逻辑回归来评估身体健康状况的发生率。本杰明-霍赫伯格校正用于解释多次测试，并且只有在整个样本（n > 22）中获得至少 1% 认可的身体健康状况才纳入分析，以降低 I 类错误的风险。我们还使用新颖的网络分析方法来测试自闭症患者和非自闭症患者之间的多重发病率是否有所增加。自闭症患者所有器官系统的非传染性疾病发生率均显着升高，包括胃肠道、神经系统、内分泌、视觉、耳/鼻/喉、皮肤、肝脏和肾脏以及血液系统疾病。我们通过显示神经系统和胃肠道症状发生率的高度显着差异（p < 0.0001）证实了之前的发现。此外，我们在迄今为止最大的样本中确定，与非自闭症女性相比，自闭症女性更容易发生埃勒-当洛斯综合症（EDS）。最后，我们发现在控制了性别、种族、居住国家、饮酒、吸烟和体重指数后，与非自闭症个体相比，自闭症个体中乳糜泻的患病率更高，但在考虑了家族史后，这些结果变得不显着。 。我们的研究对女性、白人、受过高等教育的人和英国居民存在偏见，这可能是由于抽样偏差。我们的自我报告研究设计也可能排除那些无法使用计算机或有智力障碍的人。我们的网络分析的规模也有限。这项研究提供了广泛存在的证据，使用二元逻辑回归和网络模型，与非自闭症成人相比，自闭症成人几乎所有主要器官系统的身体健康合并症。医疗保健专业人员必须了解自闭症患者中可能更常见的一系列同时发生的身体健康状况。然而，我们的研究结果也指出了需要进一步探索的潜在途径，例如自闭症与乳糜泻和 EDS 的关联。