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Hypertension Screening Performed Less Often in Children with Autism

More research is needed to identify barriers and test interventions to improve hypertension screening and CVD prevention in children with autism

New findings suggest screening for hypertension was less likely to occur during health maintenance visits for children with autism compared to children without autism.

Hypertension screening took place in 55.8% (95% CI, 37.3% - 72.8%) of visits with autism, compared to 75.7% (95% CI, 74.1% - 77.2%) without autism (P = .02).

“Our findings complement literature describing gaps in preventive care for children with autism, including decreased vaccination rates and missed well-child visits,” wrote study author James T. Nugent, MD, MPH, Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine.

It is understood that adults with autism have an increased risk for hypertension, cardiovascular disease, and death, in comparison to the general population. Screening for hypertension is recommended for children beginning at 3 years old, but barriers to blood pressure measurement in children with autism including sensory discomfort and comorbid conditions require attention during visits.

The current cross-sectional study obtained data from the multistage, nationally representative National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Investigators included visits to office-based practices and hospital outpatient departments for patients aged 3 - 21 years from 2002 - 2018 where the major reason for visit was identified as preventive care.

The study defined autism using ICD-9 or ICD-10 codes or a positive response to the question, “Does the patient now have autism?” They selected the primary outcome as to whether blood pressure was measured during the visit, based on physician records.

In reference to other chronic diseases, investigators reported the frequency of screening for hypertension during preventive visits for children with attention-deficit/hyperactivity disorder, asthma, depression, diabetes, cerebral palsy, epilepsy, and obesity.

Additionally, multivariable logistic regression was used in the evaluation of the association between autism and screening efforts, after adjustments for age, sex, race, year, physician specialty, insurance, number of chronic conditions, diabetes, and obesity.

From a total of 44,501 visits, 0.5% (95% CI, 0.4% - 0.7%) involved children with autism. Data show the median age in years (11 years versus 12 years), median previous visits in past year (1 versus 2), and visits with an obesity diagnosis (4.8% [95% CI, 1.6%-13.7%] vs 4.0% [95% CI, 3.6%-4.5%]) were similar for visits with and without an autism diagnosis.

Visits with autism were noted to have included more males (80.8% [95% CI, 69.4% - 88.6%] versus 41.7% [40.3% - 43.2%]).

When investigators divided visits into 2 periods, screenings increased over time for children without autism, but did not increase for children with autism. They additionally observed screening for children with other conditions occurred at least as often for those without the condition.

For visits wherein blood pressure was measured, hypertensive readings were performed in 16.7% (95% CI, 7.9 - 31.8) of children with autism and 15.2% (95% CI, 14.3 - 16.2) of children without autism (P = .80).

In multivariable analyses, autism was significantly associated with decreased odds of screening (odds ratio, 0.39; 95% CI, 0.17 - 0.89) and was additionally associated with decreased odds of height measurement, nutrition counseling, and exercise counseling.

The research letter, “Screening for Hypertension in Children With and Without Autism Spectrum Disorder,” was published in JAMA Network Open.