Association of Hospitalization for Infection in Childhood With Diagnosis of Autism Spectrum Disorders A Danish Cohort Study

Objective: To investigate the association between hospitalization for infection in the perinatal/neonatal period or childhood and the diagnosis of autism spectrum disorders (ASDs). Design: A population-based cohort study. Setting: Denmark. Participants: All children born in Denmark from January 1, 1980, through December 31, 2002, comprising a total of 1 418 152 children. Exposure: Infection requiring hospitalization. Main Outcome Measure: The adjusted hazard ratio (HR) for ASDs among children hospitalized for infection compared with other children. Results: A total of 7379 children were diagnosed as having ASDs. Children admitted to the hospital for any infectious disease displayed an increased rate of ASD diagnoses (HR, 1.38 [95% confidence interval, 1.31-1.45]). This association was found to be similar for infectious diseases of bacterial and viral origin. Furthermore, children admitted to the hospital for noninfectious disease also displayed an increased rate of ASD diagnoses (HR, 1.76 [95% confidence interval, 1.68-1.86]), and admissions for infection increased the rate of mental retardation (2.18 [2.06-2.31]). Conclusions: The association between hospitalization for infection and ASDs observed in this study does not suggest causality because a general association is observed across different infection groups. Also, the association is not specific for infection or for ASDs. We discuss a number of noncausal explanatory models.