自閉症譜系的全球流行病學和健康負擔：2021年全球疾病負擔研究的結果
The global epidemiology and health burden of the autism spectrum: findings from the Global Burden of Disease Study 2021
——《柳葉刀/精神病學》2025年，第12卷，第2期——
Volume 12, Issue 2, 2025
【摘要】背景：對於服務規劃者和資源分配者來說，自閉症譜系流行病學和自閉症患者的健康需求的高質量估計是必不可少的。本文介紹了2021年全球疾病、傷害和風險因素負擔研究 (GBD) 中自閉症譜系障礙的全球患病率和健康負擔，這些研究改進了流行病學數據和負擔估計方法。方法：對於GBD2021，通過系統文獻綜述，包括在PubMed、Embase、PsycINFO、全球衛生數據交換中進行搜索，並諮詢專家，確定了自閉症譜系障礙流行病學的數據。合格數據用於通過貝葉斯元回歸工具 (DisMod-MR 2.1) 估計患病率。使用模型化的患病率和殘疾權重來估計健康負擔，以殘疾生活年限 (YLD) 為非致命健康負擔的衡量標準，以殘疾調整生命年 (DALY) 為總體健康負擔的衡量標準。沒有按種族劃分的數據。有自閉症生活經歷的人參與了本文的設計、準備、解釋和撰寫。發現：2021年，全球估計有6180萬（95%不確定區間為52.1-72.7）人（每127人中就有1 人）患有自閉症。全球年齡標準化患病率為每100,000人788.3（663.8-927.2），相當於每100,000名男性中有1064.7（898.5-1245.7）名自閉症男性，每100,000名女性中有508.1（424.6-604.3）名自閉症女性。自閉症譜系障礙導致全球1150萬（7.8-16.3）DALY，相當於每100,000人（年齡標準化）中有147.6（100.2-208.2）DALY。在超級區域層面，年齡標準化的DALY率範圍從東南亞、東亞和大洋洲的每100,000人126.5（86.0-178.0）到高收入超級區域的每100,000人204.1（140.7-284.7）。DALY在整個生命周期中都很明顯，5歲以下兒童出現DALY（每100,000人169.2 [115.0-237.4] DALY），並隨着年齡的增長而減少（20歲以下每100,000人163.4 [110.6-229.8] DALY，20歲及以上每100,000人137.7 [93.9-194.5] DALY）。自閉症譜系障礙是20歲以下人群非致命健康負擔的十大原因之一。解釋：自閉症譜系障礙在20歲以下人群中的高患病率和非致命健康負擔排名突出了早期發現和支持全球自閉症青年及其護理人員的重要性。我們需要努力提高研究結果的準確性和全球代表性，首先要更好地覆蓋全球流行病學數據，以便更好地確定地理差異。本文介紹的工作可以指導未來的研究工作，更重要的是，可以指導有關分配衛生服務的決策，以更好地滿足所有自閉症患者的需求。
[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.
論文原文：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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