Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Zeyan Liew

Second Advisor

Xiaomei Ma

Abstract

AbstractBackground: Autism spectrum disorder (ASD) affects a growing number of children in the United States (US), yet substantial heterogeneity in its remains poorly understood. While previous studies have identified racial and ethnic disparities in ASD prevalence, the Asian American population is frequently treated as a single, monolithic group. This aggregation masks critical variation across distinct Asian ethnic subgroups, potentially obscuring unique barriers to diagnosis and care. This analysis aimed to investigate trends in ASD by age 6 among seven distinct maternal Asian subgroups born between 2007 and 2015 in California and evaluate the influences from maternal demographic factors and neighborhood-level socioeconomic status on these trends. Methods: We analyzed the linked database of California birth records and Department of Developmental Services (DDS) records that include 567,750 singleton births of seven Asian subgroups born in California between 2007 and 2015. The seven maternal Asian subgroups include Chinese, Filipino, Indian, Japanese, Korean, Vietnamese, and Other Southeast Asian (Cambodian, Hmong, Laotian, and Thai). Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for ASD by age 6 using the diagnostic records registered in the DDS, adjusting for the child's sex, birth year, maternal age, and maternal education. Furthermore, stratification and interaction analyses were performed for differences in the diagnostic trends across subgroups by child’s sex and maternal residential neighborhood Social Vulnerability Index (SVI). Results: A total of 6,498 children were diagnosed for ASD by age 6 (prevalence: 1.14%) in the cohort. Prevalence was highest among maternal Vietnamese (1.61%) and Filipino (1.58%) and lowest among maternal Chinese (0.70%) subgroups. While an average of 7.3% annual increase in the odds of child's ASD diagnosis (OR 1.07; 95% CI: 1.06–1.08) was estimated, the increase in trends was more robust for maternal Filipino, Indian, and Vietnamese subgroups but not the maternal Chinese subgroup (OR 0.97; 95% CI: 0.95–1.00). For instance, children born to Filipino (OR 2.41; 95% CI: 2.24–2.60) and Vietnamese (OR 2.39; 95% CI: 2.19–2.61) mothers had over two-fold higher odds for ASD compared with children born to Chinese mothers, after controlling for sociodemographic factors. Finally, the ASD upward trend was more pronounced in maternal residential areas of high social vulnerability (OR interaction 1.05; 95% CI: 1.03–1.07), but no apparent child’s sex differences were noted in the ASD trend within Asian subgroups. Conclusion: Disparities in the temporal trends of ASD exist across Asian American subgroups in California. Future investigations into the drivers for these disparities show that targeted, culturally tailored screening and support services are needed to address the widening gap within the diverse Asian American community in the US.

Comments

This is an Open Access Thesis.

Download
Open Access

This Article is Open Access

Share

COinS