Chronic Disease Incidence and Onset in Adults With Autism Spectrum Disorder: A 26-Year Matched Cohort Study

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition, yet long‑term patterns of chronic disease in autistic adults remain poorly characterized. We examined incidence and age at diagnosis of common chronic conditions in adults with ASD compared with matched controls.

We conducted a retrospective cohort study within Maccabi Health Services, including adults ≥ 18 years with documented ASD and 3:1 controls matched on age, sex, and socioeconomic status, with up to 26 years of follow‑up (1998-2024). Chronic physical and psychiatric conditions were obtained from validated registries. Time-to-event analyses were performed using Kaplan-Meier curves and Cox proportional hazards models.

The cohort comprised 6,965 adults with ASD and 20,871 controls; 51% of the ASD group versus 24.5% of controls had ≥ 1 chronic condition. Adults with ASD had higher hazards and earlier diagnosis of type 2 diabetes (HR 1.47, ~ 9 years earlier), hypertension (HR 1.24, ~ 5 years earlier), overweight/obesity (HR 1.49, ~ 7.4 years earlier), inflammatory bowel disease (HR 1.60, ~ 5 years earlier), and schizophrenia (HR 2.10, ~ 4 years earlier). Overweight status amplified diabetes and hypertension risk in ASD but not controls. No significant differences were observed for COPD or cardiovascular disease.

Adults with ASD experience earlier and greater chronic disease burden than matched peers, supporting earlier, tailored preventive care and systematic metabolic and psychiatric screening in this population.