Autism spectrum disorder is an in-hospital mortality risk factor among patients with COVID-19: A retrospective cohort study

While existing studies focus on the association between COVID-19 and the mental wellbeing of individuals with autism spectrum disorder (ASD), physiological factors might indicate an association between ASD and the clinical outcome of COVID-19. In this sense, the present work aims to investigate whether individuals with ASD are associated with increased risk of COVID-19 related in-hospital mortality. This is a retrospective cohort study. Data of individuals who were polymerase chain reaction (PCR) positive for SARS-CoV-2 were gathered from a nationwide database concerning hospitalization due to severe acute respiratory syndrome in Brazil. Individuals with and without ASD were the comparison groups. Mortality was the outcome and was measured by adjusted hazard ratio. A similar analysis yet with a mediation analysis was conducted as sensitivity analysis. A total of 1,181,114 individuals, including 250 (0.02 %) with ASD, met inclusion criteria and were included in the study. After adjusting for age, sex, ethnicity, region, and underlying comorbid conditions, patients with ASD had 45 % higher hazard of COVID-19 related death compared to those without diagnosed ASD (hazard ratio 1.455, 95 % CI 1.149–1.842). The sensitivity analysis showed similar results. Individuals with ASD are associated with increased risk of COVID-19 related in-hospital mortality. More research is needed to improve patient outcomes and risk stratification in this population. • Physiological factors might imply an association between ASD and the clinical outcome of COVID-19. • A higher risk of COVID-19 related death was observed in those with ASD. • More healthcare support of COVID-19 should be given to those with ASD.