Unintentional suffocation emergencies associated with autism and common Co-occurring diagnoses

Background People with autism are at heightened risk of specific injuries and injury-related death. As autism prevalence rises, epidemiologic data describing specific injuries, such as suffocation, across the lifespan are essential for prevention efforts. We describe the risk of unintentional suffocation-related events associated with autism and common co-occurring diagnoses among people treated in United States (US) emergency departments (EDs). Methods Using a repeated cross-sectional study design, we analyzed data from the 2016–2021 Nationwide Emergency Department Sample (NEDS), the largest US all-payer ED visit claims database. Using ICD-10-CM codes, children ≥ 1 year and adults diagnosed with autism, intellectual disability (ID), attention-deficit/hyperactivity disorder (ADHD), and Alzheimer’s disease and related dementia (ADRD) were identified and evaluated. Weighted multivariable logistic regression models were used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CIs) of unintentional suffocation-related ED visits in persons with and without autism, ID, ADHD, and ADRD. Each model was adjusted for the other conditions, age, sex, urbanicity, and payor. Results The 2016–2021 NEDS recorded a weighted total of 803,777,608 ED visits; of these, 1,012,210 (0.13%) were related to unintentional suffocation. Unintentional suffocation accounted for 0.35% of ED visits in patients with autism, 0.67% of ED visits in patients with a diagnosis of ID, 0.07% of ED visits in patients with a diagnosis of ADHD, and 0.34% of ED visits in patients with a diagnosis of ADRD. The odds of unintentional suffocation were increased 75% for patients with autism (aOR = 1.75; 95% CI: 1.65, 1.86), 556% for patients with ID (aOR = 6.56; 95% CI: 6.2, 6.94), 44% for patients with ADHD (aOR = 1.44; 95% CI: 1.35, 1.53), and 106% for patients with ADRD (aOR = 2.06; 95% CI: 2.01, 2.12). Across the lifespan, unintentional suffocation accounted for a larger proportion of ED visits among autistic than non-autistic patients. Conclusion Children and adults with autism have a significantly increased odds of unintentional suffocation requiring emergency care. ID, ADHD, and ADRD, diagnoses that often co-occur with autism, also have increased odds of unintentional suffocation, with intellectual disability conferring the greatest risk.