自闭症谱系的全球流行病学和健康负担：2021年全球疾病负担研究的结果
The global epidemiology and health burden of the autism spectrum: findings from the Global Burden of Disease Study 2021
——《柳叶刀/精神病学》2025年，第12卷，第2期——
Volume 12, Issue 2, 2025
【摘要】背景：对于服务规划者和资源分配者来说，自闭症谱系流行病学和自闭症患者的健康需求的高质量估计是必不可少的。本文介绍了2021年全球疾病、伤害和风险因素负担研究 (GBD) 中自闭症谱系障碍的全球患病率和健康负担，这些研究改进了流行病学数据和负担估计方法。方法：对于GBD2021，通过系统文献综述，包括在PubMed、Embase、PsycINFO、全球卫生数据交换中进行搜索，并咨询专家，确定了自闭症谱系障碍流行病学的数据。合格数据用于通过贝叶斯元回归工具 (DisMod-MR 2.1) 估计患病率。使用模型化的患病率和残疾权重来估计健康负担，以残疾生活年限 (YLD) 为非致命健康负担的衡量标准，以残疾调整生命年 (DALY) 为总体健康负担的衡量标准。没有按种族划分的数据。有自闭症生活经历的人参与了本文的设计、准备、解释和撰写。发现：2021年，全球估计有6180万（95%不确定区间为52.1-72.7）人（每127人中就有1 人）患有自闭症。全球年龄标准化患病率为每100,000人788.3（663.8-927.2），相当于每100,000名男性中有1064.7（898.5-1245.7）名自闭症男性，每100,000名女性中有508.1（424.6-604.3）名自闭症女性。自闭症谱系障碍导致全球1150万（7.8-16.3）DALY，相当于每100,000人（年龄标准化）中有147.6（100.2-208.2）DALY。在超级区域层面，年龄标准化的DALY率范围从东南亚、东亚和大洋洲的每100,000人126.5（86.0-178.0）到高收入超级区域的每100,000人204.1（140.7-284.7）。DALY在整个生命周期中都很明显，5岁以下儿童出现DALY（每100,000人169.2 [115.0-237.4] DALY），并随着年龄的增长而减少（20岁以下每100,000人163.4 [110.6-229.8] DALY，20岁及以上每100,000人137.7 [93.9-194.5] DALY）。自闭症谱系障碍是20岁以下人群非致命健康负担的十大原因之一。解释：自闭症谱系障碍在20岁以下人群中的高患病率和非致命健康负担排名突出了早期发现和支持全球自闭症青年及其护理人员的重要性。我们需要努力提高研究结果的准确性和全球代表性，首先要更好地覆盖全球流行病学数据，以便更好地确定地理差异。本文介绍的工作可以指导未来的研究工作，更重要的是，可以指导有关分配卫生服务的决策，以更好地满足所有自闭症患者的需求。
[Summary] Background: High-quality estimates of the epidemiology of the autism spectrum and the health needs of autistic people are necessary for service planners and resource allocators. Here we present the global prevalence and health burden of autism spectrum disorder from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 following improvements to the epidemiological data and burden estimation methods. Methods: For GBD 2021, a systematic literature review involving searches in PubMed, Embase, PsycINFO, the Global Health Data Exchange, and consultation with experts identified data on the epidemiology of autism spectrum disorder. Eligible data were used to estimate prevalence via a Bayesian meta-regression tool (DisMod-MR 2.1). Modelled prevalence and disability weights were used to estimate health burden in years lived with disability (YLDs) as the measure of non-fatal health burden and disability-adjusted life-years (DALYs) as the measure of overall health burden. Data by ethnicity were not available. People with lived experience of autism were involved in the design, preparation, interpretation, and writing of this Article. Findings: An estimated 61·8 million (95% uncertainty interval 52·1–72·7) individuals (one in every 127 people) were on the autism spectrum globally in 2021. The global age-standardised prevalence was 788·3 (663·8–927·2) per 100 000 people, equivalent to 1064·7 (898·5–1245·7) autistic males per 100 000 males and 508·1 (424·6–604·3) autistic females per 100 000 females. Autism spectrum disorder accounted for 11·5 million (7·8–16·3) DALYs, equivalent to 147·6 (100·2–208·2) DALYs per 100 000 people (age-standardised) globally. At the super-region level, age-standardised DALY rates ranged from 126·5 (86·0–178·0) per 100 000 people in southeast Asia, east Asia, and Oceania to 204·1 (140·7–284·7) per 100 000 people in the high-income super-region. DALYs were evident across the lifespan, emerging for children younger than age 5 years (169·2 [115·0–237·4] DALYs per 100 000 people) and decreasing with age (163·4 [110·6–229·8] DALYs per 100 000 people younger than 20 years and 137·7 [93·9–194·5] DALYs per 100 000 people aged 20 years and older). Autism spectrum disorder was ranked within the top-ten causes of non-fatal health burden for people younger than 20 years. Interpretation: The high prevalence and high rank for non-fatal health burden of autism spectrum disorder in people younger than 20 years underscore the importance of early detection and support to autistic young people and their caregivers globally. Work to improve the precision and global representation of our findings is required, starting with better global coverage of epidemiological data so that geographical variations can be better ascertained. The work presented here can guide future research efforts, and importantly, decisions concerning allocation of health services that better address the needs of all autistic individuals.
论文原文：Santomauro, Damian F et al. (2025). The global epidemiology and health burden of the autism spectrum: findings from the Global Burden of Disease Study 2021. The Lancet / Psychiatry, Volume 12, Issue 2, Pages 111-121, February 2025.
https://doi.org/10.1016/S2215-0366(24)00363-8
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