Spatiotemporal distribution of autism spectrum disorder prevalence among birth cohorts during 2000–2011 in Israel

Purpose: Studies indicate an apparent sharp increasing trend in autism spectrum disorder (ASD) incidence and prevalence worldwide. This nationwide study aims at depicting ASD prevalence distribution in Israel in both space and time. Methods: Based on data from Israel National Insurance Institute, the study population included all children born in Israel 2000–2011 (n = 1,786,194), of whom 11,699 (0.655%) were subsequently diagnosed with ASD (until December 31, 2016). Prevalence was calculated and mapped by dividing the number of ASD cases within each year of birth by the number of births during that year, for each spatial unit, and similarly for several spatiotemporal levels of aggregation. Results: ASD prevalence varies substantially across different geographic areas in Israel, with considerably higher prevalence concentrated in central Israel. Strong associations were found between locality-level socioeconomic index, ethnicity, and peripherality and ASD prevalence, and even after adjustment for them, excess prevalence for ASD still persisted in certain localities. No spatial dependence of prevalence, with and without adjustment for the locality-level variables, was found (Moran's I = −0.000546, −0.00335, respectively). Conclusions: Our findings provide important insights regarding health disparities affecting ASD diagnosis, directing further health policy intervention and further research.