Correlation of Month of Birth and Socioeconomic Status with Autism Spectrum Disorder: a Nationwide Study Birth months and socioeconomic status in ASD

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Ching-Lin Chu Mei Hung Chi Chia-Hung Tang Yi Ting Hsieh Tzu I Lee Yen Kuang Yang Po See Chen


The aim of this study was to investigate whether autism spectrum disorder (ASD) is associated with birth in certain months in Taiwan, as has been found in other countries. A case–control study (1:4) matched according to sex and age was conducted. The study population comprised 4.3% of the population of Taiwan, using the National Health Insurance Research Database (NHIRD) from 1996 through 2008. Multiple logistic regressions were performed after adjusting for socioeconomic factors of urbanization level and income level. A total of 965 people with ASD and 3,860 controls were recruited. In comparison with a March birth, a higher risk of ASD was found for June and August births. After adjusting for level of urbanization and income, the risk of developing ASD was still higher for June, July, and August births over the year. There was higher risk of ASD in urban area when comparing with rural area. A higher risk of ASD was found in the highest income level. A higher risk of ASD was identified among children born in summer months, and a higher risk of ASD in urban area and high socioeconomic status suggested the presence of social-environmental causes of ASD.



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Chu, C.-L., Chi, M. H., Tang, C.-H., Hsieh, Y. T., Lee, T. I., Yang, Y. K., & Chen, P. S. (2018). Correlation of Month of Birth and Socioeconomic Status with Autism Spectrum Disorder: a Nationwide Study. International Journal of Child Development and Mental Health, 6(2), 20-29. Retrieved from
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Barak, Y., Ring, A., Sulkes, J., Gabbay, U., & Elizur, A. (1995). Season of birth and autistic disorder in Israel. The American journal of psychiatry, 152(5), 798.

Bolton, P., Pickles, A., Harrington, R., Macdonald, H., & Rutter, M. (1992). Season of birth: issues, approaches and findings for autism. Journal of Child Psychology and Psychiatry, 33(3), 509-530.

Boyle, C. A., Boulet, S., Schieve, L. A., Cohen, R. A., Blumberg, S. J., Yeargin-Allsopp, M., & Kogan, M. D. (2011). Trends in the prevalence of developmental disabilities in US children, 1997–2008. Pediatrics, 127(6), 1034-1042.

Chen, C. Y., Liu, C. Y., Su, W. C., Huang, S. L., & Lin, K. M. (2007). Factors associated with the diagnosis of neurodevelopmental disorders: a population-based longitudinal study. Pediatrics, 119(2), e435-e443.

Chen, C. Y., Liu, C. Y., Su, W. C., Huang, S. L., & Lin, K. M. (2008). Urbanicity-related variation in help-seeking and services utilization among preschool-age children with autism in Taiwan. Journal of autism and developmental disorders, 38(3), 489-497.

Chen, J., Xin, K., Wei, J., Zhang, K., & Xiao, H. (2016). Lower maternal serum 25 (OH) D in first trimester associated with higher autism risk in Chinese offspring. Journal of psychosomatic research, 89, 98-101.

Delobel-Ayoub, M., Ehlinger, V., Klapouszczak, D., Maffre, T., Raynaud, J. P., Delpierre, C., & Arnaud, C. (2015). Socioeconomic disparities and prevalence of autism spectrum disorders and intellectual disability. PloS one, 10(11), e0141964.

Autism and Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators. (2014). Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Report: Surveillance Summaries, 63(2), 1-21.

Emerson, E. (2010). Deprivation, ethnicity and the prevalence of intellectual and developmental disabilities. Journal of Epidemiology and Community Health, 66(3), 218-224.

Estes, M. L., & McAllister, A. K. (2015). Immune mediators in the brain and peripheral tissues in autism spectrum disorder. Nature Reviews Neuroscience, 16(8), 469.

Fujiwara, T., Morisaki, N., Honda, Y., Sampei, M., & Tani, Y. (2016). Chemicals, nutrition, and autism spectrum disorder: a mini-review. Frontiers in neuroscience, 10, 174.

Gesundheit, B., Rosenzweig, J. P., Naor, D., Lerer, B., Zachor, D. A., Procházka, V., ... & Hwang, P. (2013). Immunological and autoimmune considerations of autism spectrum disorders. Journal of autoimmunity, 44, 1-7.

King, M. D., & Bearman, P. S. (2011). Socioeconomic status and the increased prevalence of autism in California. American sociological review, 76(2), 320-346.

Kolevzon, A., Weiser, M., Gross, R., Lubin, G., Knobler, H. Y., Schmeidler, J., ... & Reichenberg, A. (2006). Effects of season of birth on autism spectrum disorders: fact or fiction?. American Journal of Psychiatry, 163(7), 1288-1290.

Landrigan, P. J., Lambertini, L., & Birnbaum, L. S. (2012). A research strategy to discover the environmental causes of autism and neurodevelopmental disabilities.Environmental health perspectives, 120(7), a258.

Lee, L. C., Newschaffer, C. J., Lessler, J. T., Lee, B. K., Shah, R., & Zimmerman, A. W. (2008). Variation in season of birth in singleton and multiple births concordant for autism spectrum disorders. Pediatric and perinatal epidemiology, 22(2), 172-179.

Lin, C. C., Yang, S. K., Lin, K. C., Ho, W. C., Hsieh, W. S., Shu, B. C., & Chen, P. C. (2014). Multilevel analysis of air pollution and early childhood neurobehavioral development. International journal of environmental research and public health, 11(7), 6827-6841.

Lin, T. Y., Huang, Y. C., Ning, H. C., & Tsao, K. C. (2004). Surveillance of respiratory viral infections among pediatric outpatients in northern Taiwan. Journal of clinical virology, 30(1), 81-85.

Lung, F. W., Chiang, T. L., Lin, S. J., & Shu, B. C. (2013). Incinerator pollution and child development in the Taiwan birth cohort study. International journal of environmental research and public health, 10(6), 2241-2257.

Mackay, D. F., Smith, G. C., Cooper, S. A., Wood, R., King, A., Clark, D. N., & Pell, J. P. (2016). Month of conception and learning disabilities: a record-linkage study of 801,592 children. American journal of epidemiology, 184(7), 485-493.

Mazumdar, S., Liu, K. Y., Susser, E., & Bearman, P. (2012). The disappearing seasonality of autism conceptions in California. PLoS One, 7(7), e41265.

Rai, D., Lewis, G., Lundberg, M., Araya, R., Svensson, A., Dalman, C., ... & Magnusson, C. (2012). Parental socioeconomic status and risk of offspring autism spectrum disorders in a Swedish population-based study. Journal of the American Academy of Child & Adolescent Psychiatry, 51(5), 467-476.

Shi, L., Fatemi, S. H., Sidwell, R. W., & Patterson, P. H. (2003). Maternal influenza infection causes marked behavioral and pharmacological changes in the offspring. Journal of Neuroscience, 23(1), 297-302.

Stevens, M. C., Fein, D., & Waterhouse, L. H. (2000). Season of birth effects in autism. Journal of Clinical and Experimental Neuropsychology, 22(3), 399-407.

Thomas, P., Zahorodny, W., Peng, B., Kim, S., Jani, N., Halperin, W., & Brimacombe, M. (2012). The association of autism diagnosis with socioeconomic status. Autism, 16(2), 201-213.

Tonhajzerova, I., Ondrejka, I., Mestanik, M., Mikolka, P., Hrtanek, I., Mestanikova, A., … Mokra, D. (2015). Inflammatory Activity in Autism Spectrum Disorder. Advances in Experimental Medicine and Biology, 93-98.

Vinkhuyzen, A. A., Eyles, D. W., Burne, T. H., Blanken, L. M., Kruithof, C. J., Verhulst, F., … McGrath, J. J. (2016). Gestational vitamin D deficiency and autism-related traits: the Generation R Study. Molecular Psychiatry, 23(2), 240-246

Vinkhuyzen, A. A., Eyles, D. W., Burne, T. H., Blanken, L. M., Kruithof, C. J., Verhulst, F., & McGrath, J. J. (2017). Gestational vitamin D deficiency and autism spectrum disorder. British Journal of Psychiatry Open, 3(2), 85-90.

Volk, H. E., Lurmann, F., Penfold, B., Hertz-Picciotto, I., & McConnell, R. (2013). Traffic- related air pollution, particulate matter, and autism. JAMA psychiatry, 70(1), 71-77.

Zerbo, O., Iosif, A. M., Delwiche, L., Walker, C., & Hertz-Picciotto, I. (2011). Month of conception and risk of autism. Epidemiology (Cambridge, Mass.), 22(4), 469.