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10/10/2023  |   1:30 PM - 1:55 PM   |  6619

Autism Spectrum Disorder Diagnoses among Insured US Children with Congenital Cytomegalovirus Diagnoses

Abstract Summary

Objectives: To examine the association of autism spectrum disorder (ASD) diagnoses with congenital cytomegalovirus (cCMV) diagnoses in US children. Methods: We used 2014–2020 Medicaid claims data for children enrolled from birth through ?4 to <7 years. We identified cCMV (exposure), ASD (outcome), covariates (sex and region), and potential effect modifier variables (preterm birth (PTB), low birth weight (LBW), and central nervous system (CNS) anomaly/injury--brain anomaly, microcephaly, cerebral palsy, epilepsy, or chorioretinitis) using diagnostic billing codes. Hearing loss was assessed but not included as a covariate. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for sex and region both overall and stratified by PTB or LBW and by CNS anomaly/injury. Results: Among 2,989,659 children, 1,044 (3.5 per 10,000) had cCMV recorded, and 74,872 (25.0 per 1,000) had ASD recorded. PTB, LBW, CNS anomaly/injury, and hearing loss were associated with both cCMV and ASD. Children with cCMV diagnoses were more than twice as likely to have ASD diagnoses (HR: 2.5; 95% CI: 2.0?3.2, adjusting for sex and region). In stratified analyses adjusted for sex and region, among children without CNS anomaly/injury, those with cCMV were 1.6 (95% CI: 1.0?2.5) times as likely to have ASD as children without cCMV; the HR among children with CNS anomaly/injury was 1.0 (95% CI; 0.7?1.3). HRs ranged from 2.0?2.2 in strata defined by PTB or LBW, combined, alone, or neither. Conclusions: Children with (vs. without) cCMV diagnoses were more likely to have ASD diagnoses. The observed associations may reflect both a causal effect of cCMV on risk of ASD, partly mediated by CNS involvement, and confounding of CNS involvement with clinical ascertainment of cCMV or ASD. Future research investigating ASD risk among cohorts with universal cCMV screening may help elucidate these observed associations.

Learning Objectives

  • Review the existing literature regarding ASD and cCMV, and why CNS involvement may mediate the relationship between the two.
  • Discuss the implications of a possible association between cCMV and ASD, and results of this study.
  • Consider the limitations of using administrative claims data to examine this relationship and discuss the need for future research using universal screening cohorts.

Presentation

3440589_16103JessicaLeung.pdf

Handouts

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Presenters


Jessica Leung | Co-Author

JLeung@cdc.gov;
Jessica Leung is an epidemiologist in the Division of Viral Diseases at the Centers for Disease Control and Prevention. She works on infectious disease surveillance, outbreak investigations, and research-related projects on viral vaccine-preventable diseases in the United States. Ms. Leung received her BA in Biochemistry and Molecular Biology from Dartmouth College and MPH in Epidemiology of Microbial Diseases from Yale University.

ASHA DISCLOSURE

Financial - No relevant financial relationship exists.

Nonfinancial - No relevant nonfinancial relationship exists.

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


Tatiana Lanzieri | Co-Author

uyk4@cdc.gov;
Tatiana M. Lanzieri, M.D., M.P.H., is a medical epidemiologist with the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention. She has over 20 years of experience in infectious disease epidemiology, surveillance, and outbreak investigation.

ASHA DISCLOSURE

Financial - No relevant financial relationship exists.

Nonfinancial - No relevant nonfinancial relationship exists.

AAA DISCLOSURE

Financial -


Sarah Tinker | Author, Co-Author

zzu9@cdc.gov;
Sarah Tinker, PhD, MPH is an epidemiologist with National Center on Birth Defects and Developmental Disabilities of the Centers for Disease Control and Prevention. Dr. Tinker's work focuses on understanding risk factors for birth defects.

ASHA DISCLOSURE

Financial -

Nonfinancial -

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


Charles Rose | Co-Author

cvr7@cdc.gov;
Charles E. Rose, PhD, is a Senior Statistician with the Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities.

ASHA DISCLOSURE

Financial -

Nonfinancial -

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


Melissa Danielson | Co-Author

ekd6@cdc.gov;
Melissa Danielson, MSPH is a statistician with the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention.

ASHA DISCLOSURE

Financial -

Nonfinancial -

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


Marshalyn Yeargin-Allsop | Co-Author

mxy1@cdc.gov;
Marshalyn Yeargin-Allsopp, MD, is a Developmental Pediatrician, Medical Epidemiologist, and Chief of the Developmental Disabilities Branch in CDC’s National Center on Birth Defects and Developmental Disabilities. Dr. Yeargin-Allsopp joined CDC in 1981 as an Epidemic Intelligence Service (EIS) Officer and completed a Preventive Medicine Residency in 1984. After coming to CDC, she designed and implemented the first U.S. population-based studies of developmental disabilities among children. These studies laid the foundation for CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network, which has been tracking the number and characteristics of children with autism spectrum disorders and other developmental disabilities in the U.S. since 2000.

ASHA DISCLOSURE

Financial -

Nonfinancial -

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


Scott Grosse | Co-Author

sgg4@cdc.gov>;
Scott Grosse, PhD is a senior health economist at the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. He has degrees in economics and public health from the University of Michigan. He conducts health services research on rare disorders and neurodevelopmental disorders and public health strategies.

ASHA DISCLOSURE

Financial -

Nonfinancial -

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


Megan Pesch | Primary Presenter

pesch@med.umich.edu;
Dr. Pesch is a Developmental and Behavioral Pediatrician and researcher at the University of Michigan where she is the Director of the Congenital CMV Developmental Follow-up Clinic. She serves as the President of the National CMV Foundation. Her research interests include the early screening and diagnosis of congenital CMV, as well as the behavioral and developmental outcomes of children with congenital CMV. She is also a proud mother of a daughter with cCMV.

ASHA DISCLOSURE

Financial - Receives Consulting fee for Consulting from DiaSorin Molecular.   Receives Consulting fee for Consulting from MedScape.   Receives Salary for Employment from University Of Michigan.  

Nonfinancial - Has a Personal (Serve on Board of Directors) relationship for Board membership.  

AAA DISCLOSURE

Financial - Receives support from University of Michigan (all authors employed by) Pesch - speaker honoraria for diasorin, consultant for medscape/webmd Pesch and weinberg - NIH funding Pesch - Gerber foundation funding for Pesch - speaker honoraria for diasorin, consultant for medscape/webmd Pesch and weinberg - NIH funding Pesch - Gerber foundation funding.