1. Premature mortality in ASD
Tatja Hirvikoski
Associate Professor/Neuropsychologist
Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND)
Head of Research, Development and Education Habilitation & Health Stockholm

2.
Tatja Hirvikoski

3. Previous studies on mortality in ASD
Denmark
Isager et al (1999)
Mouridsen et al (2008)
Sweden
Gillberg et al (2010)
USA
Shavelle et al (2001)
Pickett et al (2006)
Bilder et al (2012)
wwww.stockholmsmuseum.se
Tatja Hirvikoski

4. Main research questions
Is there an increased risk for premature all-cause mortality in ASD?
Gender differences
Differences between ASD + ID versus ASD - ID
Which ICD categories (if any) are significant specific causes of death in ASD?
Tatja Hirvikoski

5. Premature mortality in ASD
An epidemiological study of all individuals with ASD in Swedish Patient Register
A control group from Total Population Register, matched for sex, age and county of residence
Data linked to Causes of Death Register
Odds ratios (OR) and 95% Confidence Intervals (CI) calculated for all-cause mortality and cause- specific mortality using conditional logistic regression analysis
Hirvikoski, Mittendorfer-Rutz, Boman, Larsson, Lichtenstein & Bölte (2016) British Journal of Psychiatry.
Tatja Hirvikoski

6. Odds ratio (OR)
Odds = ratio between ”event” and ”non-event” e.g. 1 suicide/ non-suicide
Odds ratio is a comparison of two groups
Odds in ASD group Odds in control group
OR = 1 no group difference
OR > 1 higher risk in the ASD group
OR = 2 two times higher risk in the ASD group
Important! Relative risk ≠ absolute numbers
Tatja Hirvikoski

7. Study groups
Tatja Hirvikoski

8. All-cause mortality
Risk for premature mortality 2.56 times higher in ASD
Increased risk for both LF and HF ASD; highest in LF ASD
Gender differences:
HF ASD group: higher risk for males
LF ASD group: higher risk for females
Tatja Hirvikoski

9. Specific causes of death categorized according to ICD-10
Infections
Neoplasms (cancer)
Endocrine
Mental and behavioural disorders
Diseases of the nervous system
Diseases of the circulatory system
Diseases of the respiratory system
Diseases of the digestive system
Diseases of the genitourinary system
Congenital malformations
Symptoms, signs, and abnormal findings not elsewhere classified
External causes of morbidity and mortality:
Intentional self-harm/suicide was analysed separately from other external causes of death
Other causes of death: In this category we included ICD-10 chapters with only a few cases
Tatja Hirvikoski

10. Specific causes of death
Increased risk in all analyzed categories (except infections) for
Total ASD group
LF ASD
HF ASD
Tatja Hirvikoski

11. Differences between LF ASD and HF ASD (specific causes of death)
LF ASD higher risk than HF ASD:
Mental and behavioral
Nervous system
Circulatory system
Respiratory system
Digestive system
Congenital malformations
HF ASD higher risk than LF ASD:
Suicide
Tatja Hirvikoski

12. Suicide

13. Suicide: general risk and protective factors
RISK FACTORS
PROTECTIVE FACTORS
Male
Older (and younger)
Single
Previous suicide attempt
Repeated suicide attempt
Suicide attempt with high intention to die
Hopelessness
Sustance abuse, e.g. alcohol
Depression (60-90% of people who commit suicide) and other psychiatric diagnoses (shizophrenia, bipolar disorder, personality disorder)
Recent serious life events
Support from partner, family and other significant others
Ability to maintain close relationships
Being responsible for children, family members and others
Personal values against suicide (e.g. religon)
Being afraid of pain or body injury
General satisfaction with life
Good coping ability
Therapeutic contact including counselling, support etc.
Tatja Hirvikoski

14. Summary Significantly increased mortality risk in ASD
Higher risk in LF ASD compared to HF ASD
Highest risk: Females with LF ASD
Increased risk in all analyzed causes of death (except infections)
Differences between LF ASD and HF ASD depending on cause of death
High suicide risk in individuals with HF ASD
Hirvikoski et al, 2016, British Journal of Psychiatry
Tatja Hirvikoski

15. Clinical implications
Better knowledge of ASD needed in all medical specialties
Focus on health and life style factors
Focus on help seeking skills
Develop and follow clinical guidelines for suicidal behaviours
If needed: local guidelines
Improve co-operation between different actors within health care organizations as well as in society in general
Martin Rinman
Tatja Hirvikoski

16. 120813

17. Thnx... For your attention!
Co-authors: Ellenor Mittendorfer-Rutz, Marcus Boman, Henrik Larsson, Paul Lichtenstein & Sven Bölte