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OBJECTIVES: In a context of rising income inequality and policies to improve rights and inclusion for persons with disabilities, this paper examines income inequality trends by household work limitation status in the United States from 1981–2018. METHODS: Data comes from the March Supplement of the Current Population Survey using the work limitation disability measure to estimate decomposable Generalized Entropy measures of income inequality, and progressivity of government transfers and disability payments. RESULTS: Over the 1981–2018 period, inequality within the group of households with work limitations has been around 30 percent higher than inequality within the group of households without work limitations. Both households with and without work limitations have seen a similar 70 percent rise in income inequality since 1981. Progressivity of government transfers and disability payments increased among households with limitations, but not among other households. CONCLUSIONS: Income inequality is higher within the group of households with work limitations compared to other households and has been rising for both groups. Policies aimed to enhance the economic and social participation of persons with disabilities over this period may have mitigated this rising trend. Disability considerations should be part of research and policy on income inequality.

Significance Rates of autism diagnosis in the United States have historically been higher among more advantaged social groups—Whites and those of higher socioeconomic status (SES). Using data from all births in the state of California in 1992 through 2016, we find that these trends reversed during our study period. By 2018, diagnosed autism incidence rates for 3- to 6-y-old children were higher for children of Black and Asian mothers than children of non-Hispanic White mothers and were higher for children of lower SES than of higher SES parents. These reversals point to the fundamental role that access to knowledge and resources plays in driving increased autism prevalence and shifting patterns of autism cases over the past quarter-century., As rates of autism diagnosis increased dramatically over the past number of decades, prevalence rates were generally highest among Whites and among those of higher socioeconomic status (SES). Using a unique, population-level dataset, we find that rates of autism diagnosis continued to be on the rise in recent years, but who is diagnosed changed during the study period. Our data consist of birth records of all 13,272,573 children born in the state of California in 1992 through 2016 linked to autism caseload records for January 1992 through November 2019 from California’s Department of Developmental Services. California’s diagnosed autism incidence rate rose from 0.49 per 1,000 3–6 y olds in 1998 to 3.49 per 1,000 3–6 y olds in 2018, a 612% increase. However, diagnosed incidence rates did not rise uniformly across sociodemographic groups. By 2018, children of Black and Asian mothers were diagnosed at higher rates than children of non-Hispanic White mothers. Furthermore, among children of non-Hispanic White and Asian mothers, children of lower SES were diagnosed at higher rates than children of higher SES. These changes align with sociological theories of health disparities and contain important clues for more fully understanding the autism epidemic.

Background Research on the impact of various types of stressors on refugee wellbeing may not readily inform those designing interventions about the supports that will be most helpful in particular settings. Composite variables used in psychosocial research that represent overarching types of stressors provide only vague information about intervention targets. Dynamic networks model individual phenomena separately (i.e., specific stressors and symptoms of distress) to inform how phenomena interact with each other in ways that may be useful for individuals planning interventions in humanitarian aid settings. Methods Using archival data from Darfur refugees, we used a dynamic networks approach to model relationships between locally-validated measures of traumatic events, displacement stressors, impairment, and distress. Results Findings aligned with previous research on the centrality of basic needs in refugee populations. Further, specific stressors were highlighted as particularly impactful for this population, and sleep and physical difficulties emerged as key aspects of distress and impairment, suggesting areas for targeted intervention. Conclusions: Dynamic network approaches may be fruitful for identifying setting-specific intervention targets and maximizing the impact of limited resources in humanitarian aid settings. Electronic supplementary material The online version of this article (10.1186/s13031-019-0212-2) contains supplementary material, which is available to authorized users.

Previous studies report associations between conception with assisted reproductive technology (ART) and autism. Whether these associations reflect an ascertainment or biologic effect is undetermined. We assessed diagnosis age and initial autism symptom severity among >30,000 children with autism from a linkage study of California Department of Developmental Services records, birth records, and the National ART Surveillance System. Median diagnosis age and symptom severity levels were significantly lower for ART-conceived than non-ART-conceived children. After adjustment for differences in the socio-demographic profiles of the two groups, the diagnosis age differentials were greatly attenuated and there were no differences in autism symptomatology. Thus, ascertainment issues related to SES, not ART per se, are likely the driving influence of the differences we initially observed.

A growing body of literature indicates that the mental distress experienced by survivors of war is a function of both experienced trauma and stressful life events. However, the majority of these studies are limited in that they 1) employ models of psychological distress that emphasize underlying latent constructs and do not allow researchers to examine the unique associations between particular symptoms and various stressors; and 2) use one or more measures that were not developed for that particular context and thus may exclude key traumas, stressful life events and symptoms of psychopathology. The current study addresses both these limitations by 1) using a novel conceptual model, network analysis, which assumes that symptoms covary with each other not because they stem from a latent construct, but rather because they represent meaningful relationships between the symptoms; and 2) employing a locally developed measure of experienced trauma, stressful life problems and symptoms of psychopathology. Over the course of 2009 to 2011, 337 survivors of the Sri Lankan civil war were administered the Penn-RESIST-Peradeniya War Problems Questionnaire (PRPWPQ). Network analysis revealed that symptoms of psychopathology, problems pertaining to lack of basic needs, and social problems were central to the network relative to experienced trauma and other types of problems. After controlling for shared associations, social problems in particular were the most central, significantly more so than traumatic events and family problems. Several particular traumatic events, stressful life events and symptoms of psychopathology that were central to the network were also identified. Discussion emphasizes the utility of such network models to researchers and practitioners determining how to spend limited resources in the most impactful way possible.

Motivated by the dramatic increase in autism diagnoses in recent years, research into risk factors has uncovered substantial variation in autism prevalence by race/ethnicity, SES, and geography. Less studied is the connection between autism diagnosis rates and the social and political context. In this article, we link the temporal pattern of autism diagnosis for Hispanic children in California to state and federal anti-immigrant policy, particularly ballot initiative Proposition 187, limiting access to public services for undocumented immigrants and their families. Using a population-level dataset of 1992–2003 California births linked to 1992–2006 autism case records, we show that the effects of state and federal policies toward immigrants are visible in the rise and fall of autism risk over time. The common epidemiological practice of estimating risk on pooled samples is thereby shown to obscure patterns and mis-estimate effect sizes. Finally, we illustrate how spatial variation in Hispanic autism rates reflects differential vulnerability to these policies. This study reveals not only the spillover effects of immigration policy on children’s health, but also the hazards of treating individual attributes like ethnicity as risk factors without regard to the social and political environments that give them salience.

Sir, We appreciate the interest of Dr Barad et al. in our analysis of the association of assisted reproductive technology (ART) treatment and parental infertility diagnosis with autism in ART-conceived children (Kissin et al., 2015). Dr Barad et al. express concern that the analysis was not adjusted ‘for race/ethnicity and/or socioeconomic status.’ We did consider both maternal race/ethnicity and education (the latter as a proxy for socioeconomic status) among other characteristics for inclusion in models that explored the association of autism with ART treatment factors and parental infertility diagnosis. Neither factor was significant in the univariable analysis and, therefore, was not included in in the models. However, in response to Dr Barad et al.’s suggestion, we refit the models with addition of these two factors. As expected, the risk estimates for the association of ICSI with autism diagnosis remained statistically significant for both singletons [adjusted hazard risk ratio, aHRR 1.73 (1.11–2.69)] and multiples [aHRR 1.51 (1.06–2.15)]. Contrary to Dr Barad et al.’s surmise that socioeconomically advantaged patients would utilize ICSI to a higher degree, there was no evidence that utilization of ICSI was significantly associated with either race/ethnicity (70% of ART users with ICSI were non-Hispanic white, compared with 70% of ART users without ICSI) or socioeconomic status (89% of ICSI users were college graduates, compared with 87% of women who used ART without ICSI). The dramatic increase in use of ICSI during the study period without similar increase in autism diagnosis in ART-conceived children can likely be explained by the relatively low prevalence of autism. Using a mathematical assessment model for estimating the effects of changes in the prevalence of individual risk factors on autism prevalence (Schieve et al., 2011), we estimate that the 82% increase of ICSI use would be expected to result in a 14.4% increase in autism among singletons, and thus a prevalence increase from0.9 to 1.03%. Likewise, the ICSI use increase we observed would be expected to result in a 15.5% autism increase among multiples, which translates to a prevalence increase from 1.2 to 1.39% among multiples. Such small increases in autism prevalence are difficult to detect with any precision. Moreover, while increasing ICSI utilization may have led to a slight increase in autism prevalence, other factors, such as the decline in multiple births among ART deliveries, might have affected the trend in the opposite direction. As we clearly noted in our article, an underlying biological mechanism through which ICSI could be associated with autism is not known and may be related to the procedure itself, characteristics of the patients selected for the procedure, or other factors. However the possibility of risk and the lack of convincing evidence of benefit do not appear to favor use of ICSI without male-factor infertility diagnosis (ASRM, 2012).

STUDY QUESTION Are assisted reproductive technology (ART) treatment factors or infertility diagnoses associated with autism among ART-conceived children? SUMMARY ANSWER Our study suggests that the incidence of autism diagnosis in ART-conceived children during the first 5 years of life was higher when intracytoplasmic sperm injection (ICSI) was used compared with conventional IVF, and lower when parents had unexplained infertility (among singletons) or tubal factor infertility (among multiples) compared with other types of infertility. WHAT IS KNOWN ALREADY Some studies found an increased risk of autism among ART-conceived infants compared with spontaneously-conceived infants. However, few studies, and none in the USA, have examined the associations between types of ART procedures and parental infertility diagnoses with autism among ART-conceived children. STUDY DESIGN, SIZE, DURATION Population-based retrospective cohort study using linkages between National ART Surveillance System (NASS) data for 1996-2006, California Birth Certificate data for 1997-2006, and California Department of Developmental Services (DDS) Autism Caseload data for 1997-2011. PARTICIPANTS/MATERIALS, SETTING, METHODS All live born ART-conceived infants born in California in 1997-2006 (n = 42 383) with 5-year observation period were included in the study. We assessed the annual incidence of autism diagnosis documented in DDS, which includes information on the vast majority of persons with autism in California, and the association of autism diagnosis with ART treatment factors and infertility diagnoses. MAIN RESULTS AND THE ROLE OF CHANCE Among ART-conceived singletons born in California between 1997 and 2006, the incidence of autism diagnosis remained at ∼0.8% (P for trend 0.19) and was lower with parental diagnosis of unexplained infertility (adjusted hazard risk ratio [aHRR]; 95% confidence interval: 0.38; 0.15-0.94) and higher when ICSI was used (aHRR 1.65; 1.08-2.52), when compared with cases without these patient and treatment characteristics. Among ART-conceived multiples, the incidence of autism diagnosis between 1997 and 2006 remained at ∼1.2% (P for trend 0.93) and was lower with parental diagnosis of tubal factor infertility (aHRR 0.56; 0.35-0.90) and higher when ICSI was used (aHRR 1.71; 1.10-2.66). LIMITATIONS, REASONS FOR CAUTION Study limitations include imperfect data linkages, lack of data on embryo quality and possible underestimation of autism diagnosis cases. Limitations of the observational study design could affect the analysis by the possibility of residual confounders. Since information about ICSI use was missing for most frozen/thawed embryo transfer cycles, our findings of association of ICSI use and autism diagnosis can only be generalizable to fresh embryo transfer cycles. WIDER IMPLICATIONS OF THE FINDINGS Our study provides additional evidence of the association between some types of ART procedures with autism diagnosis. Additional research is required to explain the increased risk of autism diagnosis with ICSI use, as well as studies on the effectiveness and safety of ICSI.

Objectives. We assessed the association between assisted reproductive technology (ART) and diagnosed autistic disorder in a population-based sample of California births. Methods. We performed an observational cohort study using linked records from the California Birth Master Files for 1997 through 2007, the California Department of Developmental Services autism caseload for 1997 through 2011, and the Centers for Disease Control and Prevention’s National ART Surveillance System for live births in 1997 through 2007. Participants were all 5 926 251 live births, including 48 865 ART-originated infants and 32 922 cases of autism diagnosed by the Department of Developmental Services. We compared births originated using ART with births originated without ART for incidence of autism. Results. In the full population, the incidence of diagnosed autism was twice as high for ART as non-ART births. The association was diminished by excluding mothers unlikely to use ART; adjustment for demographic and adverse prenatal and perinatal outcomes reduced the association substantially, although statistical significance persisted for mothers aged 20 to 34 years. Conclusions. The association between ART and autism is primarily explained by adverse prenatal and perinatal outcomes and multiple births.

The incidence and prevalence of autism have dramatically increased over the last 20 years. Decomposition of autism incidence rates into age, period and cohort effects disentangle underlying domains of causal factors linked to time trends. We estimate an age-period-cohort effect model for autism diagnostic incidence overall and by level of functioning.Data are drawn from sequential cohorts of all 6 501 262 individuals born in California from 1992 to 2003. Autism diagnoses from 1994 to 2005 were ascertained from the California Department of Development Services Client Development and Evaluation Report.Compared with those born in 1992, each successively younger cohort has significantly higher odds of an autism diagnosis than the previous cohort, controlling for age and period effects. For example, individuals born in 2003 have 16.6 times the odds of an autism diagnosis compared with those born in 1992 [95% confidence interval (CI) 7.8-35.3]. The cohort effect observed in these data is stronger for high than for low-functioning children with an autism diagnosis.Autism incidence in California exhibits a robust and linear positive cohort effect that is stronger among high-functioning children with an autism diagnosis. This finding indicates that the primary drivers of the increases in autism diagnoses must be factors that: (i) have increased linearly year-to-year; (ii) aggregate in birth cohorts; and (iii) are stronger among children with higher levels of functioning.

Internet job searching offers an empirical setting in which to explore the trade-off between quality and quantity of information. As both firms and workers turn to the internet for unprecedented amounts of labor market information, it is unclear whether this makes the matching process more efficient. Using longitudinal data on two samples of unemployed job searchers in 1998 and 2000, I establish the rise of the internet as a job-search strategy and assess whether searching online increased the short-term probability of finding a job. Results suggest the internet's contribution to an unemployed searcher's information pool may afford a small advantage only to the extent that other job searchers are not using it, perhaps due to an inverse relationship between search and screening costs in a two-sided market.

OBJECTIVE: The goal of this study was to describe the typical longitudinal developmental trajectories of social and communication functioning in children with autism and to determine the correlates of these trajectories. METHODS: Children with autism who were born in California from 1992 through 2001 and enrolled with the California Department of Developmental Services were identified. Subjects with RESULTS: Six typical patterns of social, communication, and repetitive behavior functioning were identified. These trajectories displayed significant heterogeneity in developmental pathways, and children whose symptoms were least severe at first diagnosis tended to improve more rapidly than those severely affected. One group of ∼10% of children experienced rapid gains, moving from severely affected to high functioning. Socioeconomic factors were correlated with trajectory outcomes; children with non-Hispanic, white, well-educated mothers were more likely to be high functioning, and minority children with less-educated mothers or intellectual disabilities were very unlikely to experience rapid gains. CONCLUSIONS: Children with autism have heterogeneous developmental pathways. One group of children evidenced remarkable developmental change over time. Understanding what drives these outcomes is thus critical.

Background The incidence and prevalence of autism have dramatically increased over the last 20 years. Decomposition of autism incidence rates into age, period and cohort effects disentangle underlying domains of causal factors linked to time trends. We estimate an age-period-cohort effect model for autism diagnostic incidence overall and by level of functioning. Methods Data are drawn from sequential cohorts of all 6 501 262 individuals born in California from 1992 to 2003. Autism diagnoses from 1994 to 2005 were ascertained from the California Department of Development Services Client Development and Evaluation Report. Results Compared with those born in 1992, each successively younger cohort has significantly higher odds of an autism diagnosis than the previous cohort, controlling for age and period effects. For example, individuals born in 2003 have 16.6 times the odds of an autism diagnosis compared with those born in 1992 [95% confidence interval (CI) 7.8–35.3]. The cohort effect observed in these data is stronger for high than for low-functioning children with an autism diagnosis. Discussion Autism incidence in California exhibits a robust and linear positive cohort effect that is stronger among high-functioning children with an autism diagnosis. This finding indicates that the primary drivers of the increases in autism diagnoses must be factors that: (i) have increased linearly year-to-year; (ii) aggregate in birth cohorts; and (iii) are stronger among children with higher levels of functioning.

Background The incidence of autism rose dramatically between 1992 and 2001, while the age at which children were first diagnosed declined. During this period the size and composition of the autism caseload has changed, but little is known about whether the factors associated with the timing of diagnosis may also have shifted. Using a multilevel analysis strategy, the individual and community-level factors associated with age of diagnosis were modelled across 10 birth cohorts of California children. Methods Linked birth and administrative records on 17185 children with diagnoses of autistic disorder born in California between 1992 and 2001 and enrolled with the California Department of Developmental Services (DDS) were analysed. Information on cases, their parents and their residential location were extracted from birth and DDS records. Zip codes of residence were matched to census data to create community-level measures. Multilevel linear models were estimated for each birth cohort, with individual-level effects for sex, race, parental characteristics, poverty status, birth order and symptom expression. At the community level measures of educational and economic composition, local autism prevalence and the presence of a child psychiatrist were included. Results Children with highly educated parents are diagnosed earlier, and this effect has strengthened over time. There is a persistent gap in the age of diagnosis between high and low socioeconomic status (SES) children that has shrunk but not disappeared over time. Conclusion Routine screening for autism in early childhood for all children, particularly those of low SES, is necessary to eliminate disparities in early intervention.

Objectives. We sought to estimate the risk for autism associated with maternal and paternal age across successive birth cohorts. Methods. We linked birth records and autism diagnostic records from the California Department of Developmental Services for children born in California between 1992 and 2000 to calculate the risk associated with maternal and paternal age for each birth cohort as well as for the pooled data. Results. The categorical risks associated with maternal age over 40 years ranged from a high of 1.84 (95% confidence interval [CI] = 1.37, 2.47) to a low of 1.27 (95% CI = 0.95, 1.69). The risk associated with paternal age ranged from 1.29 (95% CI = 1.03, 1.6) to 1.71 (95% CI = 1.41, 2.08). Conclusions. Pooling data across multiple birth cohorts inflates the risk associated with paternal age. Analyses that do not suffer from problems produced by pooling across birth cohorts demonstrated that advanced maternal age, rather than paternal age, may pose greater risk. Future research examining parental age as a risk factor must be careful to avoid the paradoxes that can arise from pooling data, particularly during periods of social demographic change.