Unintentional suffocation emergencies associated with autism and common Co-occurring diagnoses

People with autism are at heightened risk of specific injuries and injury-related death. As autism prevalence rises, epidemiologic data describing specific injuries, such as suffocation, across the lifespan are essential for prevention efforts. We describe the risk of unintentional suffocation-related events associated with autism and common co-occurring diagnoses among people treated in United States (US) emergency departments (EDs).

Using a repeated cross-sectional study design, we analyzed data from the 2016-2021 Nationwide Emergency Department Sample (NEDS), the largest US all-payer ED visit claims database. Using ICD-10-CM codes, children ≥ 1 year and adults diagnosed with autism, intellectual disability (ID), attention-deficit/hyperactivity disorder (ADHD), and Alzheimer's disease and related dementia (ADRD) were identified and evaluated. Weighted multivariable logistic regression models were used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CIs) of unintentional suffocation-related ED visits in persons with and without autism, ID, ADHD, and ADRD. Each model was adjusted for the other conditions, age, sex, urbanicity, and payor.

The 2016-2021 NEDS recorded a weighted total of 803,777,608 ED visits; of these, 1,012,210 (0.13%) were related to unintentional suffocation. Unintentional suffocation accounted for 0.35% of ED visits in patients with autism, 0.67% of ED visits in patients with a diagnosis of ID, 0.07% of ED visits in patients with a diagnosis of ADHD, and 0.34% of ED visits in patients with a diagnosis of ADRD. The odds of unintentional suffocation were increased 75% for patients with autism (aOR = 1.75; 95% CI: 1.65, 1.86), 556% for patients with ID (aOR = 6.56; 95% CI: 6.2, 6.94), 44% for patients with ADHD (aOR = 1.44; 95% CI: 1.35, 1.53), and 106% for patients with ADRD (aOR = 2.06; 95% CI: 2.01, 2.12). Across the lifespan, unintentional suffocation accounted for a larger proportion of ED visits among autistic than non-autistic patients.

Children and adults with autism have a significantly increased odds of unintentional suffocation requiring emergency care. ID, ADHD, and ADRD, diagnoses that often co-occur with autism, also have increased odds of unintentional suffocation, with intellectual disability conferring the greatest risk.