Abstract
In a cohort of kindergarten children in Ontario, Canada with Autism Spectrum Disorder (ASD) (n = 1522), we tested the association of age at ASD diagnosis and characteristics of (1) the child’s primary care provider and, (2) the child using health administrative databases. We tested the association of primary care practice model and time from developmental delay identification to age at ASD diagnosis. Older age of diagnosis was associated with provider foreign training (vs. domestic) (adjusted Hazard Ratio [aHR] 1.17, 95% CI 1.03, 1.33) but not sex, care model, and years of practice. After developmental delay identification, children with paediatricians had longer time to diagnosis than children with providers in care models (aHR 0.68, 95% CI 0.54, 0.86). Findings can be used to inform primary care provider ASD training.
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Data Availability
The data set from this study is held securely in coded form at ICES. Data-sharing agreements prohibit ICES from making the data set publicly available, but access may be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS. The full data set creation plan and underlying analytic code are available from the authors upon request, understanding that the programs may rely upon coding templates or macros that are unique to ICES.
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Acknowledgments
We would like to thank Dr. Astrid Guttmann for her contributions to the study design.
Funding
This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH). The first author received a Brain Canada-Kids Brain Health Network Pre-Doctoral Fellowship to complete this study as part of her PhD thesis. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOH is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI) and Immigration, Refugees Citizenship Canada (IRCC). However, the analyses, conclusions, opinions and statements expressed herein are those of the authors, and not necessarily those of CIHI or IRCC. This study was also supported by a Canadian Institute of Health Research Foundation Grant (CIHR – 142416).
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AS conceptualized and designed the study, analyzed and interpreted the results, drafted the initial manuscript, revised the manuscript, and approved the final manuscript as submitted. NS and MJ conceptualized and designed the study, interpreted the results, revised the manuscript, and approved the final manuscript as submitted. FS designed the study, interpreted the results, revised the manuscript, and approved the final manuscript as submitted. RM, ED, KG interpreted the results, revised the manuscript, and approved the final manuscript as submitted. AS and HZ had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Natasha Saunders reports receiving an honorarium from Archives of Diseases in Childhood, outside of the submitted work. No other competing interests were declared. All authors have no conflicts of interest relevant to this article to disclose.
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Siddiqua, A., Janus, M., Mesterman, R. et al. Primary Care Provider and Child Characteristics Associated with Age of Diagnosis of Autism Spectrum Disorder: A Population-Based Cohort Study. J Autism Dev Disord 52, 2896–2910 (2022). https://doi.org/10.1007/s10803-021-05165-8
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DOI: https://doi.org/10.1007/s10803-021-05165-8