Autism prevalence trends over time in Denmark: changes in prevalence and age at diagnosis.
OBJECTIVE
To examine the effect of changing age at diagnosis on the diagnosed prevalence of autism among different birth cohorts.


METHODS
Population-based cohort study.


METHODS
Children were identified in the Danish Medical Birth Registry and psychiatric outcomes were obtained via linkage with the Danish National Psychiatric Register.


METHODS
All children born in Denmark from January 1, 1994, through December 31, 1999 (N = 407 458).


METHODS
The age-specific prevalence, hazard ratio, and relative risk by age.


RESULTS
Statistically significant shifts in age at diagnosis were observed for autism spectrum disorder; children diagnosed before age 9 years in the cohorts born between January 1, 1994, and December 31, 1995, between January 1, 1996, and December 31, 1997, and between January 1, 1998, and December 31, 1999, were on average diagnosed at ages 5.9 (95% confidence interval [CI], 5.8-6.0), 5.8 (95% CI, 5.7-5.9), and 5.3 (95% CI, 5.2-5.4) years, respectively. The relative risk comparing the 1996-1997 birth cohort with the 1994-1995 birth cohort at age 3 years was 1.20 (95% CI, 0.86-1.67), which decreased to 1.10 (95% CI, 1.00-1.20) at age 11 years. Similarly, the relative risk comparing the 1998-1999 birth cohort with the 1994-1995 birth cohort at age 3 years was 1.69 (95% CI, 1.24-2.31), which decreased to 1.23 (95% CI, 1.11-1.37) at age 11 years. Similar results were observed for childhood autism.


CONCLUSIONS
Shifts in age at diagnosis inflated the observed prevalence of autism in young children in the more recent cohorts compared with the oldest cohort. This study supports the argument that the apparent increase in autism in recent years is at least in part attributable to decreases in the age at diagnosis over time.
Parner
Erik T
ET
Department of Biostatistics, Institute of Public Health, University of Aarhus, Vennelyst Boulevard 6, DK-8000 Aarhus C, Denmark. parner@biostat.au.dk
Schendel
Diana E
DE
Thorsen
Poul
P
D000367:Age Factors; D001321:Autistic Disorder / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors