Socioeconomic and Geographic Disparities in Autism Spectrum Disorder: A Case-Control Study in Bangladesh

Global research consistently identifies significant disparities in the diagnosis of Autism Spectrum Disorder (ASD), strongly associated with family socioeconomic status and geographic location. However, such data from low-resource settings like Bangladesh is critically lacking. This case-control study aimed to characterize the socioeconomic and geographic profiles of children clinically diagnosed with ASD at a major tertiary centre in Bangladesh. The study was conducted at Department of Pediatrics, Mymensingh Medical College & Hospital, Bangladesh; Institute of Pediatric Neurodisorder and Autism (IPNA), BMU; Institute of Child and Mother Health (ICMH), Dhaka, Bangladesh from June 2021 to May 2022, enrolling 25 children with ASD and 25 typically developing controls aged 3-16 years. Data on key demographic indicators, including parental education, family income, place of birth and residence characteristics, were collected through parental interviews. Statistical analyses revealed profound disparities. Children with ASD were significantly more likely to come from families with higher parental education (Fathers: 80.0% vs. 16.0%; Mothers: 76.0% vs. 12.0%), higher monthly family income (92.0% vs. 44.0%) and an urban birthplace (80.0% vs. 32.0%). Furthermore, residence near a high-traffic road was a strongly associated environmental factor (92.0% vs. 44.0%). These findings highlight significant inequities in the pathway to an ASD diagnosis in Bangladesh, which are likely driven by differential access to specialized healthcare, varying levels of parental awareness and the urban concentration of diagnostic services rather than causal risk factors. The results underscore an urgent public health imperative: to develop and implement equitable strategies that enhance ASD awareness, decentralize diagnostic capabilities and ensure that all children in Bangladesh, irrespective of their socioeconomic background or place of residence, have an equal opportunity for timely identification and support.