Medicaid Data Show Autistic Americans Live Nearly 14 Years Less, Most Deaths Called Preventable

People with autism spectrum disorder on Medicaid are dying, on average, 13.8 years earlier than the general U.S. population, according to a study published in JAMA Network Open by researchers at Columbia University Mailman School of Public Health and the University of Colorado Anschutz.

Life expectancy at birth for Medicaid beneficiaries with autism came out to 64.9 years. That's 5.6 years shorter than the overall Medicaid population and 13.8 years shorter than Americans generally, according to lead author Guohua Li, MD, DrPH, a professor of epidemiology at Columbia Mailman.

Researchers pulled data from the Transformed Medicaid Statistical Information System and the Children's Health Insurance Program Statistical Information System, linked to the National Death Index, covering all 50 states and D.C. from 2000 through 2020. Over that 21-year window, 2,048,046 people with autism were enrolled in Medicaid. Of those, 18,268 died.

The Numbers Behind the Gap

Medicaid beneficiaries with autism had a 44% higher overall mortality risk than the rest of the Medicaid population, a standardized mortality ratio of 1.44, according to the study. But that overall number hides some brutal specifics.

Death from influenza was over 10 times more common (SMR 10.55). Malnutrition-related death was more than 7.5 times more common (SMR 7.56). Pneumonitis from inhaling solids or liquids ran nearly 7 times higher (SMR 6.92). Non-transportation accidents were up 4.48 times, accidental drowning 3.26 times, and pneumonia 3.06 times.

These aren't exotic diseases. Flu shots exist. Malnutrition is a failure of basic caregiving or access to food and nutrition support. Drowning deaths point to supervision gaps, not genetic destiny.

"The good news is that much of the excess mortality among people with autism spectrum disorder is avoidable through improved social support, primary care, and home- and community-based services," Li said in a statement accompanying the study, as reported by MedPage Today.

Some Progress, Gap Still There

Life expectancy for Medicaid beneficiaries with autism did improve during the study period, rising 1.7 years, from 63.9 years in 2000-2004 to 65.6 years in 2015-2019, according to Columbia's own release on the findings. But the gap compared to both the broader Medicaid population and the general U.S. population didn't close. It just moved with the tide.

The study also found the life expectancy shortfall was worse for autistic women than autistic men when compared to the general population, even though estimates were broadly similar across sex and racial groups otherwise, according to News Medical's coverage of the findings.

What the Study Doesn't Settle

This is Medicaid data, meaning it captures a population that is by definition lower-income and dependent on public insurance. It doesn't tell us whether autistic Americans on private insurance face the same mortality gap, and the study doesn't claim to. The underlying research acknowledges this limitation implicitly by restricting itself to Medicaid enrollees.

Separately, there's an ongoing scientific debate about what's driving the broader rise in autism diagnoses in the first place, an entirely different question from this mortality study. The Epoch Times reported that researchers like Michael Skinner of Washington State University point to a 50-fold increase in worldwide chemical production since the 1950s, with air pollution and organophosphate pesticides among the suspects under study. That reporting doesn't address life expectancy at all, and it shouldn't be confused with the Columbia mortality findings. The causes of rising autism prevalence and the causes of premature death among autistic people already diagnosed are two separate scientific questions, and conflating them muddies both.

Funding and Access

Li's proposed fix—more home- and community-based services, more primary care access, more social support—sounds simple until you look at who pays for it. Medicaid home- and community-based services are administered state by state with waiting lists that in some states stretch for years, according to longstanding reporting on Medicaid HCBS waiver programs. If a preventable-death problem this severe is tied to service gaps, state Medicaid agencies and Congress will face pressure to explain why flu vaccination, nutrition support, and basic supervision aren't reaching a population already flagged as high-risk since the late 1980s, per Li's own statement.

The unresolved question is whether any state or federal agency responds to this specific data with a policy change, or whether it joins prior mortality research from the same era Li cited, acknowledged and then shelved.