Influenza showed the widest gap between observed and expected deaths among autistic people enrolled in Medicaid, with flu deaths running about 10.5 times the rate expected from comparison groups, according to a JAMA Network Open study highlighted by CIDRAP.
Three of the six causes with the highest ratios involved the lungs: flu, pneumonitis from inhaled food or liquid, and pneumonia. The findings arrive as the fall respiratory season approaches and the CDC's vaccine advisory committee remains sidelined by litigation.
For parents and other caregivers of autistic children and adults, the figures are a reason to plan for flu season early. They describe population patterns, not any one person's risk.
Flu Topped the List of Excess Deaths
Researchers at Columbia University and the University of Colorado Anschutz analyzed Medicaid data linked to National Death Index records for all U.S. Medicaid beneficiaries from 2000 to 2020, a group that included more than 2 million people with autism. Compared with other enrollees, autistic beneficiaries had the highest sex-standardized mortality ratios for flu (10.55), malnutrition (7.56), pneumonitis caused by inhaling solids or liquids (6.92), non-vehicle accidents (4.48), drowning (3.26), and pneumonia (3.06).
A ratio of 10.55 means roughly 10 to 11 flu deaths for every one expected based on rates in the comparison group. Overall, autistic enrollees had a 44% higher risk of death than other beneficiaries.
Life expectancy fell across all groups studied in 2020, the first year of the COVID-19 pandemic, but the largest drop, 4.1 years compared with 2015 through 2019, occurred among autistic people.
Lead author Guohua Li of Columbia said much of the excess mortality "is avoidable through improved social support, primary care, and home- and community-based services," according to CIDRAP. Li also discussed the study in a university news release, and the full paper appears in JAMA Network Open.
MedicalDaily previously reported the study's headline finding that autistic Medicaid enrollees' estimated life expectancy was 64.9 years, 13.8 years below that of the general U.S. population and 5.6 years below that of all Medicaid enrollees.
A Fall Season with Less Federal Guidance
The CDC lists people with neurologic and neurodevelopmental conditions among those at higher risk of serious flu complications, along with people with certain disabilities that affect muscle function, lung function, coughing, or swallowing. The agency says vaccination is especially important for higher-risk groups and recommends prompt antiviral treatment when they have confirmed or suspected flu. A clinician can say whether these categories apply to a specific person.
The CDC's Advisory Committee on Immunization Practices (ACIP) has not issued flu or COVID-19 guidance for the season, CIDRAP reported. A March court order blocked the committee as reconstituted by Health Secretary Robert F. Kennedy Jr., and the panel has not met since.
Medical societies have stepped in. James Campbell, chair of the American Academy of Pediatrics' Committee on Infectious Diseases, said "everyone 6 months of age and older is recommended to get the flu vaccine," CIDRAP reported. William Schaffner of Vanderbilt Health, a spokesperson for the Infectious Diseases Society of America, told the outlet that insurers have said they will cover this season's flu and COVID-19 vaccines.
Timing matters, too. STAT reported in mid-September that flu and COVID-19 were not yet causing much illness and that, because flu vaccine protection wanes over the season, it can make sense to wait until flu activity starts rising, if possible. Families who need extra time to prepare a loved one for appointments may prefer to book early.
What the Medicaid Records Cannot Show
This was an observational study of administrative records, so it shows associations, not causes. Medicaid serves people with low incomes and people with disabilities, so autistic enrollees are likely to have lower socioeconomic status and more severe symptoms than autistic people outside the program. The authors cautioned that this could lead to an underestimate of life expectancy for the wider autistic population.
They also noted that autistic enrollees are disproportionately children, young adults, and men compared with the reference populations, which raises concerns about bias from unmeasured confounding in the mortality ratios. The records end in 2020, before more recent changes in vaccines and care.
The burden was not evenly shared. Autistic women lived 16.0 fewer years than women in the general U.S. population, while autistic men lived 11.6 fewer years than men overall. The authors attributed the larger gap among women to more psychiatric conditions and the excess deaths that result.
Flu Planning for Autistic Children and Adults
Ask a clinician now whether a flu shot is due for your family member and whether a pneumococcal vaccine is recommended. Ask whether the person qualifies for early antiviral treatment and how to reach the office quickly if symptoms start, since the CDC recommends prompt treatment for people at higher risk.
Flu can cause fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue, and some children also have vomiting or diarrhea. When a person has difficulty describing how they feel, caregivers may need to watch closely for fever, faster breathing, or refusal to eat or drink. Trouble breathing, bluish lips, chest pain, confusion, seizures, or signs of dehydration require emergency care.
Frequent coughing or choking during meals is worth raising with a doctor, since pneumonitis from inhaled food or liquid had the third-highest ratio in the study. A swallowing evaluation may help.
On cost, infectious disease experts expect this season's shots to be covered. In Minnesota, the state health department says that immunizations the CDC recommended as of Dec. 31, 2025, remain fully covered without cost sharing by most insurance plans. Medicaid families can call their plan to confirm where shots are covered.
A federal appeals court is scheduled to hear arguments Oct. 6 in the case that sidelined the advisory committee. MedicalDaily will follow that case and any programs aimed at the preventable causes of death the researchers identified.
Most autistic people will not die of flu, but the findings give caregivers a concrete reason to settle vaccine and treatment plans before the season peaks.
Key Questions Answered
What did the study find about flu?
Among autistic Medicaid enrollees, flu deaths ran about 10.5 times the expected rate, the highest ratio of any cause reported.
Which other causes stood out?
Malnutrition, pneumonitis from inhaled food or liquid, non-vehicle accidents, drowning, and pneumonia all ran well above expected rates.
Does this mean every autistic person faces this risk?
No. The study used Medicaid records and shows population patterns. It does not predict any individual's risk or prove cause and effect.
Is autism considered a high-risk condition for flu?
The CDC lists neurologic and neurodevelopmental conditions among higher-risk groups. A clinician can say whether that applies to a specific person.
Who is recommending flu shots this year?
With the federal advisory committee sidelined, medical societies such as the American Academy of Pediatrics recommend flu vaccination for everyone 6 months and older.
Will insurance cover the flu vaccine?
An infectious disease expert told CIDRAP that insurers have said they will cover this season's shots. Families can confirm with their plan.
When should caregivers seek emergency care?
Seek emergency care for trouble breathing, bluish lips, chest pain, confusion, seizures, or signs of dehydration.
