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A new study indicates that autistic individuals enrolled in Medicaid have a life expectancy nearly 14 years shorter than the general United States population. The research highlights specific health conditions and accidents driving this gap, pointing to a need for better long-term healthcare for autistic adults. The findings were published in JAMA Network Open.
Autism is a lifelong developmental condition that affects how people communicate, learn, and interact with the world. Symptoms and support needs vary widely from person to person, ranging from mild social challenges to profound communication difficulties requiring full-time assistance. Because it is often diagnosed in childhood, much of the past research on autism has focused on its biological origins, early screening, and educational interventions. In recent years, public health experts have shifted more attention toward understanding the long-term physical health and quality of life of autistic adults.
This growing focus includes exploring how long autistic people live and what factors affect their mortality. For example, a 2023 systematic review suggested that autistic people face more than twice the risk of dying prematurely compared to the general population. In addition, research covered by PsyPost in 2024 indicates that autistic individuals tend to experience higher rates of chronic physical health disorders across almost all major organ systems.
While this elevated risk was already documented, the exact disparity in life expectancy measured in years remained unknown.
“It has been speculated since the late 1980s that autism might shorten life expectancy,” lead researcher Guohua Li, a professor of epidemiology and anesthesiology at the Columbia University Irving Medical Center, told PsyPost. “Due to inadequate sample sizes and age-specific mortality data, life expectancy for the autistic population remained unknown.”
“Life expectancy is the most important indicator of the overall health status for a defined population,” Li added. “Our study is the first in time to determine the life expectancy for the autistic population.”
To solve this problem, Li and his colleagues turned to Medicaid records. Medicaid is a public health insurance program in the United States that provides coverage for low-income individuals and people with disabilities.
To conduct the study, the research team analyzed nationwide data from the Transformed Medicaid and Children’s Health Insurance Program Statistical Information System. They linked these detailed health records to the National Death Index, a centralized database of death record information on file in state vital statistics offices. The final dataset included all Medicaid beneficiaries across the 50 states and the District of Columbia between the years 2000 and 2020.
The study focused on a massive sample of 2,048,046 Medicaid beneficiaries diagnosed with autism. The group was predominantly male, making up about 76 percent of the sample, while females accounted for roughly 24 percent. The researchers used a statistical method called a life table, which calculates average life expectancy by looking at the death rates of a specific group at various ages. They also compared the specific causes of death among autistic individuals to the causes of death in the broader Medicaid population in 2010.
The team found that the average life expectancy at birth for Medicaid beneficiaries with autism was 64.9 years. This number is 5.6 years shorter than the life expectancy for the overall Medicaid population. When compared to the general population of the United States, the gap widened to 13.8 years.
“The COVID-19 pandemic cut the life expectancy in the US by 2.2 years,” Li explained. “The life expectancy deficit facing autistic people in the US is equivalent to the impact of six simultaneous COVID-19-like pandemics. Put it another way, autistic people in the US have the same life expectancy as the general population in Haiti or Angola.”
When breaking the data down by gender, life expectancy was similar for autistic men, who lived an average of 64.6 years, and autistic women, who lived an average of 65.0 years. However, because women in the general population tend to outlive men, the relative life expectancy deficit was larger for autistic women. Autistic women on Medicaid lost 16 years of life expectancy compared to the general United States female population, while autistic men lost 11.6 years compared to the general United States male population.
The researchers also observed changes over the two decades covered by the study. From the early 2000s to the late 2010s, life expectancy for autistic beneficiaries increased slightly, growing from 63.9 years to 65.6 years. In 2020, during the first year of the COVID-19 pandemic, life expectancy dropped across all demographics in the United States, reflecting the heavy toll of the virus. However, the autistic population on Medicaid experienced the largest drop, losing 4.1 years of life expectancy compared to the previous five-year period.
“The impact of the COVID-19 pandemic on life expectancy for the autistic population was twice as much as for the general population, which underscores the exceptional vulnerability of this growing population group with special needs,” Li noted.
Beyond overall life expectancy, the researchers analyzed the specific health problems driving these early deaths. Autistic individuals on Medicaid had a 44 percent higher overall risk of death compared to the general Medicaid population. The excess mortality was driven by a variety of distinct illnesses and accidents rather than a single cause.
“Autistic people are at heightened risk of premature death due in large part to preventable causes such as influenza, malnutrition, pneumonia, and drowning,” Li said.
Some causes of death were heavily elevated compared to typical rates. Deaths from influenza were more than ten times higher than expected for the Medicaid population. Deaths linked to malnutrition were seven and a half times higher. Pneumonitis caused by inhaling food or liquid into the lungs occurred nearly seven times more often. Autistic beneficiaries also experienced elevated rates of fatal accidents, with deaths from accidental drowning occurring more than three times as often as expected.
“This finding is sadly surprising to me,” Li said of the elevated risk of dying from malnutrition. “Causes underlying this finding may include neglect, maltreatment, poverty, and impaired ability of selfcare.”
As with all research, there are a few things to keep in mind when interpreting these findings. Medicaid is a public program designed to help individuals with low incomes or qualifying disabilities. Because of this, autistic people enrolled in Medicaid tend to have fewer financial resources or more severe symptoms than autistic individuals covered by private insurance. The life expectancy calculated in this study might underestimate the true average life expectancy for the entire autistic population in the United States.
Another detail to consider is the demographic makeup of the Medicaid population. The autistic beneficiaries in the database were disproportionately children, young adults, and males when compared to the broader population. While the researchers adjusted their statistical models to account for age and sex, there may be other unmeasured factors related to these demographics that influenced the mortality rates.
Even with these limitations, the findings highlight a need for specialized medical support for autistic individuals across their lifespans. Providing better preventative care for infectious diseases like influenza, screening for nutritional issues, and taking safety precautions to prevent accidents could help narrow the life expectancy gap.
“Our long-term goal is to close the life expectancy gap facing autistic people by improving social support, home- and community-based services, and healthcare,” Li said.
The study, “Autism Spectrum Disorder and Life Expectancy Among Medicaid Beneficiaries,” was authored by Guohua Li, Carolyn G. DiGuiseppi, Ashley Blanchard, Matthew T. Russell, and Caleb Ing.