Global, Regional, and National Burden of Autism Spectrum Disorder: Trends and Decomposition Analysis From 1990 to 2021, and Projections for 2045

Abstract

Background: Autism Spectrum Disorder (ASD) has rising global prevalence and lifelong impacts. We quantified its 1990–2021 burden using Estimated Annual Percent Change (EAPC) trends, decomposition analysis, and the Nordpred model to project burdens to 2045.

Methods: This study analyzed the global, regional, and national ASD burden from 1990 to 2021 using the Global Burden of Disease (GBD) 2021 database, assessing prevalent cases, Disability-Adjusted Life Years (DALYs), Age-Standardized Prevalence Rate (ASPR), and Age-Standardized Disability-Adjusted Life Years Rate (ASDR). It used EAPC to analyze trends, decomposition analysis to examine contributors, and the Nordpred model for predictions to 2045.

Results: From 1990 to 2021, prevalent cases rose from 41,929,995.80 to 61,823,539.64, males more affected. ASPR increased from 773.25 to 788.34/100,000, ASDR from 144.51 to 147.56/100,000. The number of DALYs increased by 3.68 million (95 % Uncertainty Interval 3.20–4.10 million) from 1990 to 2021. Middle Socio-demographic Index (SDI) regions saw the largest increases, High SDI regions minimal growth. Among 21 GBD regions, high-income Asia Pacific grew fastest, Oceania declined. Nationally, Japan, South Korea, and Singapore had the highest 2021 ASPR/ASDR, Bangladesh, Brazil, and Nepal the lowest. Decomposition analysis showed population growth drove prevalent cases and DALYs increases, aging caused declines. Predictive models estimate 71,782,946 cases by 2045, DALYs peaking at 13,365,467 years. ASPR and ASDR expected to peak in 2029 (792.16/100,000) and 2034 (148.55/100,000), then decline.

Conclusion: The rising ASD burden requires immediate action, particularly in middle SDI regions and high-income Asia Pacific, where growth is speeding up. Early intervention and equitable resource distribution for high-risk groups like males and fast-growing populations are essential to cut projected case and DALY increases by 2045.