Autistic Adults On Medicaid Are Dying 14 Years Too Soon, Study Finds

People with autism who rely on Medicaid live to an average age of just 64.9 years, nearly six years shorter than other Medicaid enrollees and almost 14 years shorter than the average American. That’s the central finding of a new analysis of more than two million Medicaid beneficiaries with autism, and it shows just how much shorter life can be for autistic people who depend on Medicaid. The new study, published in the journal JAMA Network Open, set out to close that gap.”

Researchers from Columbia University and the University of Colorado combed through two decades of Medicaid records to answer a question nobody had nailed down before: how long do autistic people actually live, and what is cutting their lives short? Earlier research showed that people with autism die at higher rates than everyone else, but no one had calculated an actual life expectancy number for this group, mostly because the data needed to do it didn’t exist in one place.

Many of those lost years trace back to causes that hit this group far harder than expected. Flu deaths among autistic Medicaid beneficiaries occurred at more than ten times the rate seen in the wider Medicaid population, one of several outsized gaps involving illnesses and accidents that are often preventable or treatable.

How Researchers Measured Autism Life Expectancy

To answer that, the team pulled records from a national Medicaid database that tracks health coverage and links to a federal death registry, so it also captures actual death outcomes. They analyzed Medicaid records covering beneficiaries across all 50 states and Washington, D.C. from 2000 through 2020. Within that pool, they identified 2,048,046 people who had an autism diagnosis on record. Most, about 76%, were male, while roughly 24% were female. The group was racially and ethnically mixed: close to half were white, about 17% were Hispanic, nearly 15% were Black, and the rest identified with other racial or ethnic backgrounds.

Using the same statistical methods insurance companies and demographers use to estimate how long people will live, the researchers calculated life expectancy for autistic Medicaid beneficiaries and compared it with the broader Medicaid population and the general U.S. public. They also compared death rates for specific causes among autistic beneficiaries to what would be expected if they died at the same rate as the general Medicaid population, a way of showing how much more often certain causes of death struck this group.

Inside the Autism Life Expectancy Gap

Life expectancy at birth for autistic Medicaid beneficiaries came out to 64.9 years. The wider Medicaid population lived 5.6 years longer on average, and the general U.S. population lived nearly 14 years longer.

Sex made little difference within the autistic Medicaid group itself. Autistic men lived to about 64.6 years and autistic women to about 65, a small gap. But when researchers compared each group to same-sex peers outside the autistic population, a starker pattern showed up. Autistic women lost about 8.2 years compared to other Medicaid women and 16 years compared to women in the general U.S. population. Autistic men, while still worse off, lost less ground: about 1.9 years compared to other Medicaid men and 11.6 years compared to men generally. Being autistic appears to cost women more years of life relative to their peers than it does men, a disparity the study’s authors said may stem from higher rates of mental health conditions that occur alongside autism in women.

Progress appeared over time. Between the early 2000s and the late 2010s, life expectancy for autistic Medicaid beneficiaries climbed by 1.7 years, from 63.9 to 65.6. The gap with everyone else never closed, though. Then came 2020. Life expectancy dropped for every group that year as the COVID-19 pandemic swept through the country, but autistic Medicaid beneficiaries took the hardest hit of the three groups studied, losing 4.1 years compared to the previous five-year period.

What’s Driving the Higher Death Rates

Autistic Medicaid beneficiaries had a 44% higher risk of death than other Medicaid enrollees. That extra risk wasn’t concentrated in one or two diseases. It showed up almost everywhere researchers looked, though some causes stood out.

Death from flu was more than ten times as common among autistic beneficiaries as would be expected. Malnutrition killed people at nearly eight times the expected rate. A lung condition caused by inhaling food, liquid, or vomit into the airways showed nearly seven times the expected death rate. Accidents unrelated to traffic occurred at more than four times the expected rate, and accidental drowning happened at more than three times the expected rate. Pneumonia deaths were roughly three times higher than expected as well.

These numbers point to something beyond biology alone. Several of the causes with the largest gaps, including flu, malnutrition, pneumonia, and drowning, are often preventable or treatable. Study authors say the findings could guide targeted efforts to cut preventable deaths among autistic people, one of the country’s most at-risk populations.

Closing the Gap

This study cannot pin down exactly why autistic Medicaid beneficiaries live shorter lives. What it does show is that many of them die from causes medicine already knows how to prevent or treat. Medicaid is designed to serve people with fewer resources and more severe health needs, so this analysis almost certainly captures some of the most at-risk autistic people in the country rather than the entire autistic population. Even so, a 14-year gap in life expectancy deserves attention from doctors, caregivers, and policymakers alike. Closing it will take more than awareness. It will take steady, consistent care aimed squarely at the deaths that never had to happen.

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