Study links food allergy to autism spectrum disorder in children

A portrait of Assistant Professor Wei Bao of the Department of Epidemiology in the University of Iowa College of Public Health.
Wei Bao

A new study from the University of Iowa finds that children with autism spectrum disorder (ASD) are more than twice as likely to suffer from a food allergy than children who do not have ASD.

Wei Bao, assistant professor of epidemiology at the UI College of Public Health and the study’s corresponding author, says the finding adds to a growing body of research that suggests immunological dysfunction as a possible risk factor for the development of ASD.

“It is possible that the immunologic disruptions may have processes beginning early in life, which then influence brain development and social functioning, leading to the development of ASD,” says Bao.

The study analyzed the health information of nearly 200,000 children gathered by the U.S. National Health Interview Survey (NHIS), an annual survey of American households conducted by the U.S. Centers for Disease Control and Prevention. The children were between the ages of 3 and 17 and the data were gathered between 1997 and 2016.

The study found that 11.25 percent of children reportedly diagnosed with ASD have a food allergy, significantly higher than the 4.25 percent of children who are not diagnosed with ASD and have a food allergy.

Bao says his study could not determine the causality of this relationship given its observational nature. But previous studies have suggested possible links—increased production of antibodies, immune system overreactions causing impaired brain function, neurodevelopmental abnormalities, and alterations in the gut biome. He says those connections warrant further investigation.

“We don’t know which comes first, food allergy or ASD,” says Bao, adding that another longitudinal follow-up study of children since birth would be needed to establish temporality.

He says previous studies on the association of allergic conditions with ASD have focused mainly on respiratory allergy and skin allergy, and those studies have yielded inconsistent and inconclusive results. The new study found 18.73 percent of children with ASD suffered from respiratory allergies, whereas only 12.08 percent of children without ASD had such allergies, and 16.81 percent of children with ASD had skin allergies, well above the 9.84 percent of children without ASD.

“This indicates there could be a shared mechanism linking different types of allergic conditions to ASD,” says Bao.

Bao says the study is limited in that the NHIS depends on respondents to voluntarily self-report health conditions, so the number of children with ASD or allergies may be misreported by those taking the survey. But he says the large number of respondents and ethnic and gender cross-representation of the survey are major strengths.

The study, “Association of Food Allergy and Other Allergic Conditions with Autism Spectrum Disorder in Children,” was published online in the June 8 issue of JAMA Network Open. The first author is Guifeng Xu, PhD candidate in the UI College of Public Health and graduate research assistant in the UI Roy J. and Lucille A. Carver College of Medicine. Additional co-authors include Linda G. Snetselaar, professor of epidemiology in the UI College of Public Health; Jin Jing, professor of maternal and child health at the Sun Yat-Sen University in China; Buyun Liu, postdoctoral researcher in the UI College of Public Health; and Lane Strathearn, professor of pediatrics in the Carver College of Medicine.

This story originally appeared in Iowa Now

Additional Media Coverage

American Journal of Managed Care
http://www.ajmc.com/newsroom/is-there-a-link-between-autism-food-allergies-study-offers-hint-but-no-answers

Express News
http://expressdigest.com/children-with-autism-twice-as-likely-to-have-had-food-allergies/

HealthDay
https://consumer.healthday.com/cognitive-health-information-26/autism-news-51/allergies-more-common-in-kids-with-autism-734691.html

Healio
https://www.healio.com/family-medicine/pediatrics/news/online/%7B95efa83e-fbe7-4394-985c-75a11948d613%7D/food-allergies-common-in-children-with-autism

Dermatology News
https://www.mdedge.com/edermatologynews/article/167673/pediatrics/allergies-linked-autism-spectrum-disorder-children

 

Wright takes a closer look at hospital readmission rates

A portrait of Brad Wright of the University of Iowa College of Public Health.

For the past several years, health care reform efforts have focused on reducing preventable hospital readmissions. However, a new study co-authored by Brad Wright, assistant professor of health management and policy at the University of Iowa, suggests that when the rising number of patients hospitalized for outpatient observation is factored in, declines in readmissions disappear.

According to the study, “Commercial payers and state Medicaid agencies have increasingly [required] hospitals to report data on readmissions and…occasionally [link] reimbursement and purchasing agreements to performance. Consequently, although experts continue to challenge the usefulness of readmission rates for assessing quality of care, the rates are now broadly accepted as a measure of hospital quality by payers and policymakers.”

right and lead author Amber K. Sabbatini, assistant professor of emergency medicine at the University of Washington, studied data for the period between 2007 and 2015 from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database. They examined claims for emergency department visits that resulted in observation stays and followed these patients to measure 30-day readmission trends. These data were used to compare observation stay readmission trends to inpatient stay readmission trends.

Sabbatini and Wright found that while inpatient readmissions decreased from 17.8% to 15.5% during the study period, 30-day readmissions after an outpatient observation stay increased from 10.9% to 14.8%. The data also showed that repeat observation stays increased from 3.6% to 6.9%.

While some may be tempted to see these results as evidence of hospitals using observation stays to game readmissions measures and avoid the penalties associated with them, Sabbatini and Wright stress that this is not the case. Rather, the study concludes that observation stays should be considered part of 30-day readmission quality measurements in order to ensure that hospitals focus the same amount of resources on preventing readmissions in these patients.

“All patients with an acute condition require timely and coordinated care,” the authors wrote. “Moreover, there is no reason to think that a repeat observation stay is any less preventable or less reflective of the quality of care transitions than an inpatient readmission. Although repeat observation stays cost payers less than inpatient readmissions, they still represent excess costs for the health care system and are meaningful for patients.”

Additional Media Coverage

HealthLeaders Media
http://www.healthleadersmedia.com/quality/readmissions-are-down-unless-you-consider-rise-observation-stays

Healthcare Informatics
https://www.healthcare-informatics.com/blogs/mark-hagland/payment/rethinking-observation-stays-and-readmissions-experts-study-issue

Managed Health Care Connect
https://www.managedhealthcareconnect.com/content/omitting-observational-stays-readmission-measures-hurts-quality-measurement

Mueller testifies at Senate hearing on rural health care

On May 24, Keith Mueller, interim dean of the University of Iowa College of Public Health and director and chair of RUPRI’s Rural Health Initiatives, testified at a United States Senate Finance Committee Public Hearing on rural health. The hearing focused on challenges and opportunities in rural health care delivery.