Prevalence of autism spectrum disorders (ASD) in 4 - 17 years old population: Puerto Rico, 2011

Background: Although it is now recognized that Autism spectrum disorders (ASD) is highly prevalent, there is limited data on the epidemiology of ASD in Hispanic populations. We conducted a population-based survey of ASD among 4 to 17 year old children in Puerto Rico (PR) in 2011. Objective: Estimate the prevalence of ASD in PR, its comorbidities, and the impact on the health system. Methods: Conducted a telephone-based random-digit-dial of the 9 health regions of PR using a structured survey based on questions of the National Survey of Children Health (NSCH) and the National Health Interview Survey (NHIS) translated to Spanish. ASD was defined based on parent or guardian report: a health care provider indicated that the child has an ASD. Results: The prevalence of ASD was 1.62% [95% IC: 1.4-1.9]. The gender ratio was 6.5:1. Prevalence by health region was similar and not statistically different from the island-wide rate of ASD. Comorbid disorders were frequently reported including gastrointestinal conditions (30%), food allergies (23%) and respiratory allergies (30%) among others. Insurance coverage was 98%, but nearly half reported that insurance did not cover the needed health services. Conclusions: ASD in Puerto Rico is among the highest in the United States following New Jersey and Utah. Comorbid conditions are common among individuals with ASD and there is an important gap in health coverage among those with health insurance. These results underscore the urgent need to increase efforts to address needs of families impacted by ASD at all ages in Puerto Rico.