Trends and Burden of Autism Spectrum Disorder in BRICS Countries: A Global Burden of Disease Analysis from 1990 to 2021

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This study aims to update the understanding of ASD burden in BRICS countries (Brazil, Russia, India, China, South Africa, Saudi Arabia, Iran, Egypt, Ethiopia, and the United Arab Emirates) using data from 1990 to 2021. Data from the Global Burden of Disease (GBD) 2021 database were analyzed. Joinpoint regression analysis was used to identify trends and changes in ASD metrics over time. Decomposition analysis quantified the impact of population growth, aging, and epidemiological changes on DALYs. Bayesian age-period-cohort analysis forecasted future trends in prevalence up to 2030. From 1990 to 2021, age-standardized prevalence (ASPR) of ASD in BRICS countries increased from 677.18 to 708.47 per 100,000, while age-standardized DALYs rate (ASDALYR) rose from 126.68 to 132.84 per 100,000. Decomposition analysis showed that population growth was the main driver of increased DALYs, with aging and epidemiological changes significantly impacting Russia and China. Future trends predicted by BAPC model indicated varied trajectories, with China, South Africa, Ethiopia, Iran, and Saudi Arabia still on the rise. The findings highlight the growing burden of ASD in BRICS countries, emphasizing the need for tailored public health interventions and improved diagnostic practices. The study underscores the importance of addressing the social and economic factors influencing ASD prevalence and DALYs. Future research should focus on understanding the underlying causes and developing effective support strategies for individuals with ASD and their families. Autism Spectrum Disorder Joinpoint Decomposition analysis Bayesian age-period-cohort analysis BRICS GBD 2021 Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1 Introduction Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in social interaction and communication, as well as repetitive behaviors and restricted interests. Individuals with ASD are usually found in their early childhood. Moreover, it was estimated that, 618,000 individuals (1 in every 127 individuals) are affected by ASD globally[ 1 ]. Long-term of ASD leads to impairment for children with ASD, their families, and society[ 2 ]. The extensive investment of time and energy in caring for individuals with ASD can help reduce the negative impact of autism on families and society[ 3 ]. However, social livelihood issues greatly affect the extent of investment of time and energy[ 4 ]. The BRICS countries (Brazil, Russia, India, China, South Africa, Saudi Arabia, Iran, Egypt, Ethiopia, and the United Arab Emirates) are undergoing significant economic and social changes, generating the remarkable increase of social livelihood issues[ 5 ]. Thus, individuals with ASD and the burden of ASD in the BRICS countries should deserve more attention. In this study, we updated cognition for GBD about ASD in individuals in the BRICS countries using data from 1990 to 2021. 2 Methods 2.1 Data sources The data used in this study were obtained from the Global Burden of Disease (GBD) 2021 database. The GBD data are publicly accessible through the IHME’s online platform ( https://vizhub.healthdata.org/gbd-results/ ). GBD 2021 is the only publicly available database that allows ASD comparisons across the ten BRICS countries, yet the validity of its estimates remains contingent on the availability of primary data and cross-cultural differences in diagnostic practices[ 6 ]. The model imposes YLL = 0 for ASD, potentially underestimating premature mortality risks[ 7 ], and GBD has not disclosed the disability weights for ASD or how these are adjusted for comorbidities such as epilepsy or intellectual disability[ 8 ]. Consequently, all DALY figures reported below reflect “health loss” within the GBD framework and should not be interpreted as a judgment on the inherent value of autistic individuals’ lives. 2.2 Definitions The burden of ASD in the BRICS countries was evaluated using the incidence, prevalence, and DALYs. Prevalence refers to the proportion of the population affected by ASD at a given time. Incidence refers to the proportion of new cases affected by ASD within a specific period of time. All estimates were expressed as counts per thousand and rates per 100,000 population. The 95% uncertainty interval (UI) was calculated from the 2.5th and 97.5th percentiles of an ordered set of 1,000 draws. YLDs were determined by multiplying the prevalence by their corresponding disability weights. YLLs were calculated by multiplying the number of deaths in each age group by remaining life expectancy for that age group. DALYs were obtained by summing YLLs and YLDs. In GBD 2021, the disability weight (DW) assigned to ASD is 0.262 (95% UI 0.175–0.364), derived from global health surveys without further stratification for the presence or absence of co-occurring conditions[ 9 ]. Age-standardized populations were calculated using the GBD world population age standard. Because in GBD YLL of ASD is zero in GBD, YLDs and DALYs values are identical[ 10 ]. 2.3 Statistical Analysis 2.3.1 Join point regression analysis To evaluate trends over time, we employed joinpoint regression analysis using Joinpoint R package. This method was used to analyze trends and identify specific periods of significant change in each country’s ASD metrics, and used to calculate the Average annual percent change (AAPC) for the entire time and Annual Percentage Change (APC) for various time segments[ 11 ]. A downward trend was indicated if both the AAPC estimate and its 95% CI upper and lower bounds are lower than 0. These metrics provided a detailed understanding of the shifting epidemiological burden across the BRICS countries. In addition to the APC, age-standardized rates for incidence were calculated for each country. We also compared the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR) and age-standardized DALYs rate (ASDALYR) between males and females to assess sex disparities in the burden of ASD. Data were analyzed using 95% uncertainty intervals (UI) to account for variability and estimate the precision of APC and AAPC. 2.3.2 Decomposition analysis To understand the increased disease burden caused by ASD globally over the past 30 years, we used decomposition analysis to quantitatively analyze driving factors (population growth, population aging, epidemiological changes) leading to changes in DALYs. For disease burden, the effect obtained from decomposition analysis refers to the impact of change of a driving factor on the total DALYs when other driving factors are held constant. Moreover, the sum of the effects of all driving factors was equal to the change in DALYs. 2.3.3 Bayesian age-period-cohort analysis The Bayesian Age-Period-Cohort (BAPC) model is eligible for addressing uncertainty and incorporates past data and probability distributions, thereby being used to estimate future trend of ASD with considerations for age, period, and cohort effects. Thus, we used this model to delineate and forecast the trend of the prevalence of ASD up to 2030. Because there are not the incidence data for ASD across the vast majority of age groups in the GBD database, we did not predict the incidence of ASD. 3 Results 3.1 Trends of ASD in the BRICS GBD 2021 estimated that in 1990, the ASPR and ASDALYR of Iran, Egypt, India, China, and Brazil were below the global level. The ASIR of India, Brazil, and China were also below the global level. By 2021, ASPR and ASDALYR of Iran had exceeded the global level and Iran, Egypt, Saudi Arabia, and the United Arab Emirates joined the ranks of countries with ASIR below the global level (Fig. 1). In terms of change from 1990 to 2021, the number of cases of ASD increased from 18 million people to 25 million people in the BRICS, corresponding to increase of the ASPR of ASD from 677.18 per 100,000 (95% UI = 565.07–802.10) to 708.47 per 100,000 (95% UI = 591.70–838.76) (AAPC = 0.15, 95% CI: 0.14–0.15). The number of incidences of ASD declined from 467,354.20 to 380,300.95 in the BRICS. DALYs increased from 1990 (3,333,619.00) to 2021 (4,721,012.05) (AAPC = 0.16, 95% CI: 0.15–0.16). Indeed, the ASDALYR of ASD increased from 126.68 per 100,000 (95% UI = 86.79–178.37) in 1990 to 132.84 per 100,000 (95% UI = 90.52–187.10) in 2021. The ASPR and ASDALYR showed enhanced trend in the BRICS. Additionally, compared with other countries in the BRICS, Egypt, the United Arab Emirates, and Saudi Arabia had negative AAPC (Table 1 , Supplemental Table 1, Supplemental Table 2). Table 1 Age standardized prevalence of ASD and AAPC from 1990 to 2021. 1990 2021 AAPC_95%CI Number _95%UI ASPR Number _95%UI ASPR Global 41929995.80(35349447.65, 49633545.88) 773.25(648.35, 914.97) 61823539.64(52067672.56, 72711237.69) 788.31(662.06, 928.33) 0.06 (0.06,0.06) BRICS 17734757.69(14836126.94, 20993212.01) 677.18 (565.07, 802.10) 25278551.68(21156031.84, 29905473.21) 708.47(591.70, 838.76) 0.15 (0.14, 0.15) China 7347263.76(6120000.60, 8699968.38) 612.61(509.51, 725.16) 9078613.46(7559642.06, 10816937.47) 655.69(545.41, 781.29) 0.22 (0.22,0.23) Brazil 934491.96(777483.49, 1110612.17) 608.35(505.05, 723.03) 1335516.02(1118732.46, 1591669.50) 614.09(512.43, 731.03) 0.03 (0.03,0.03) India 6260915.69(5254093.96, 7405449.89) 702.56(587.55, 832.48) 10120041.83(8503425.42, 11876618.86) 708.06(593.06, 833.02) 0.03 (0.02,0.03) Russian 1342411.31(1129810.44, 1588282.36) 902.13(758.86, 1067.92) 1286224.88(1079417.25, 1526744.95) 928.76(777.35, 1100.04) 0.09 (0.09,0.09) South Africa 344036.20(289551.83, 404947.88) 892.64(747.46, 1053.43) 524999.04(440584.04, 623271.81) 911.73(763.79, 1079.23) 0.07 (0.07,0.07) Egypt 431930.52(360259.26, 514118.23) 747.76(619.91, 891.32) 827877.45(692545.01, 982172.67) 763.69(636.20, 906.83) 0.07 (0.07,0.07) Saudi Arabia 130755.76(109552.59, 155236.41) 793.47(660.71, 943.51) 316318.99(261845.67, 377151.72) 817.80(674.79, 974.18) 0.1 (0.1,0.1) Iran 458912.64(387003.71, 544338.67) 771.06(647.63, 913.96) 677139.66(567412.62, 799867.63) 791.19(661.59, 934.86) 0.08 (0.08,0.09) United Arab Emirates 16389.83(13613.95, 19766.74) 833.10(689.75, 1003.29) 85810.91(71622.28, 101886.84) 840.84(701.50, 1001.46) 0.03 (0.02,0.04) Ethiopia 467650.02(394757.10, 550491.27) 861.04(721.82, 1017.08) 1026009.42(860805.03, 1209151.77) 894.59(48.12, 1056.37) 0.12 (0.12,0.13) UI: Uncertainty Interval, CI: confidence interval, BRICS: Brazil, Russian Federation, India, China, South Africa, Egypt, Ethiopia, Saudi Arabia, Iran, United Arab Emirates; ASPR: Age-standardized prevalence rate, AAPC: Average Annual Percentage Change. There existed the increased trend of ASPR and ASDALYR of ASD in global and the BRICS from 1990 to 2021 (Fig .2, Supplemental Fig. 1). The overall ASIR in Egypt, Saudi Arabia, and the United Arab Emirates declined (Supplemental Fig. 2). In the BRICS, individuals affected by ASD also exhibit the same gender differences between males and females as observed globally[ 12 ]. Interestingly, United Arab Emirates and Saudi Arabia exhibited similar rapid increasing trend of cases and the number DALYs of ASD from 2005 to 2021. The cases and the number of DALYs of ASD in the Russian Federation have not changed significantly. All countries in the BRICS displayed similar trends of ASPR and ASDALYR (Fig. 3, Supplemental Fig. 3). China had a similar trend of incidence with Iran, Russian Federation and Saudi Arabia and Egypt had a similar trend of ASIR with South Africa and United Arab Emirates (Fig. 4). In 2021, the global cases and the number DALYs of ASD reached their peaks between 5 and 9 years old, and then gradually decreased with increasing age. However, in the BRICS countries, there was a noticeable upward trend after the age of 30, especially in China, Iran, Russia, Saudi Arabia, and the United Arab Emirates (Fig. 5, Supplemental Fig. 4). 3.2 Aging and epidemiological changes greatly contribute to the change of DALYs of Russian Federation and China We used decomposition analyses to investigate the effect of aging, population and epidemiological change on the change of DALYs. Population growth is the main reason for the increase in ASD DALYs. Brazil, India, South Africa, Ethiopia, Iran (Islamic Republic of), Egypt, Saudi Arabia, and United Arab Emirates had relative similar contribution of aging, population and epidemiological change to the change of DALYs. Of note, aging and epidemiological changes had major contribution to the change of DALYs of Russian Federation and China (Table 2 ). Table 2 The percentage contributions of aging, population, and epidemiological change to the DALYs of ASD from 1990 to 2021. Location Overall difference Aging (%) Population (%) Epidemiological change (%) Global 3675651.08 -281710.89 (-7.66%) 3758723.07 (102.26%) 198638.90 (5.4%) BRICS 1387393.06 -185569.25 (-13.38%) 1424125.67 (102.65%) 148836.62 (10.73%) India 719006.79 -56717.81 (-7.89%) 758526.84 (105.5%) 17197.76 (2.39%) China 307773.12 -93992.09 (-30.54%) 292919.08 (95.17%) 108846.13 (35.37%) Ethiopia 105984.11 -1557.13 (-1.47%) 102466.43 (96.68%) 5074.80 (4.79%) Egypt 74697.13 -1504.61 (-2.01%) 74095.29 (99.19%) 2106.45 (2.82%) Brazil 72441.98 -12242.10 (-16.9%) 82622.22 (114.05%) 2061.85 (2.85%) Iran (Islamic Republic of) 39589.79 -5237.21 (-13.23%) 42278.05 (106.79%) 2548.95 (6.44%) Saudi Arabia 34415.12 -652.98 (-1.9%) 34169.46 (99.29%) 898.64 (2.61%) South Africa 32812.48 -2817.19 (-8.59%) 34301.03 (104.54%) 1328.65 (4.05%) United Arab Emirates 12882.83 66.40 (0.52%) 12829.07 (99.58%) -12.64 (-0.1%) Russian Federation -12210.29 -10914.53 (89.39%) -10081.8 (82.57%) 8786.03 (-71.96%) ASD: Autism Spectrum Disorder, BRICS: Brazil, Russian Federation, India, China, South Africa, Egypt, Ethiopia, Saudi Arabia, Iran, United Arab Emirates; DALYs: Disability adjusted life years. 3.3 Anisotropic trends of prevalence of ASD from 2022 to 2030 Downward trends of ASPR were predicted using BAPC model in Brazil, India, Egypt, and the United Arab Emirates from 2022 to 2030. However, among Brazil, India, Egypt, and the United Arab Emirates, the ASPR in male Brazilian will exhibit an upward trend possibly. By contrast, the age-standardized prevalence will display an upward trend for males and females in China, South Africa, Ethiopia, Iran, and Saudi Arabia. However, ASPR will decline in females of the other BRICS countries except China, South Africa, Ethiopia, Iran, and Saudi Arabia. The ASPR in the Russian Federation will remain stable from 2022 to 2030. (Fig. 6) 4 Discussion In this study, we revealed significant trends and differences in the epidemiological burden of ASD in the BRICS, highlighting the necessity for tailored public health interventions and further research. Over the past three decades, the prevalence and DALYs of ASD in the BRICS have significantly increased: both the ASPR of ASD and the ASDALYR rose from 1990 to 2021. Similarly, the prevalence of ASD has risen dramatically from 1990 to 2021 globally[ 1 ]. The increase in prevalence of the BRICS can be attributed to several factors, including improved diagnostic capabilities and increased awareness of ASD. The changes of environmental and genetic risk factors also contribute to the increasing incidence of ASD[ 13 ]. The rising DALYs documented the significant health burden associated with ASD, emphasizing the need for comprehensive support services and interventions to improve the quality of life for individuals with ASD and their families. Additionally, the social and economic devastation caused by the Gulf War may have led to increased stress levels in pregnant women, further increasing the prevalence and DALYs of ASD in Egypt and Saudi Arabia[ 13 ]. But at present, no empirical study has established a direct link between prenatal stress during the Gulf War and an increased prevalence of ASD; this hypothesis awaits verification through specifically designed epidemiological research. From 1990 to 2021, the ASPR and ASDALYR of ASD showed a significant upward trend globally[ 1 ]. This trend was also reflected in the BRICS, indicating that the countries except for Russia faced similar challenges in addressing the disease burden. Notably, the United Arab Emirates and Saudi Arabia also exhibited a similar rapid increase in cases and the number DALYs of ASD from 2005 to 2021. Urbanization renders living pressure on people. Indeed, the urbanization in the United Arab Emirates and Saudi Arabia accelerated between 2000 and 2010[ 14 ]. Living pressure of parents is associated with risks of ASD in children. The lack of significant changes in cases and the number of DALYs of ASD in Russian Federation may be due to the low diagnostic and awareness levels[ 15 ]. Regarding the shift of the peak cases and the peak number DALYs of ASD towards higher age groups, the increase of cases and the number DALYs of ASD among individuals over the age of 30 in China, Russia, and Iran could be attributed to the severity of aging. With improvement of awareness and diagnostic, more middle-aged individuals may be diagnosed with ASD. For the United Arab Emirates and Saudi Arabia. For instance, many families in the Gulf Cooperation Council (GCC) believe that an ASD diagnosis is a stigma and, owing to their belief in the will of Allah. Thus, they resist this stigma and refuse to seek medical attention[ 16 ], thereby leading to an underestimation of cases and the number DALYs of ASD among young people. Decomposition analysis is eligible for investigating the factors affecting the changes of DALYs. We found that aging leads to a decrease in ASD DALYs in China, while epidemiological changes lead to an increase in ASD DALYs in China, because aging primarily affects the elderly population, while the peak incidence of ASD is formed in childhood and adolescence. As the proportion of the elderly population increases, the ASDALYR for ASD may relatively decrease owing to the increased share of the elderly in the total population denominator[ 17 ]. Diagnostic capabilities are improved and diagnostic criteria, increasing awareness of ASD in China. Additionally, social development and changes in lifestyle lead to an increase in the DALYs associated with ASD[ 18 ]. Severe population aging[ 19 ], combined with its limited diagnostic capabilities and awareness of ASD, may lead to a decrease in the DALYs of ASD in Russia[ 15 ]. Aging contributed less to the change of DALYs in Egypt, United Arab Emirates, and Saudi Arabia, partly owing to high population growth rate of Islamic countries[ 20 ]. By contrast, aging that contributed greater to the change of DALYs in Iran may be due to economic sanctions[ 21 ]. Limitations The GBD 2021 estimates for ASD rely on modelled extrapolations rather than country-specific epidemiological surveys, and their validity is influenced by differences in diagnostic criteria, reporting systems, and comorbidity-coding strategies[ 6 , 8 , 22 ]. The assumption of YLL = 0 overlooks the heightened risk of premature death in individuals with ASD due to unintentional injuries, suicide, or associated comorbidities[ 7 ]. DALYs and their associated disability weights are regarded by some members of the autistic community as pejorative; this study employs them solely within the GBD technical framework and does not intend to label ASD as a “burden”[ 23 ]. Any speculation linking the Gulf War to ASD remains hypothetical, as direct evidence connecting prenatal stress during that period to ASD incidence is lacking and should be examined in future ecological or case–control studies. Conclusion This study provides a comprehensive analysis of the trends and burden of ASD in the BRICS using the latest data from the Global Burden of Disease 2021. Our findings highlight the increasing prevalence and DALYs of ASD, the significant sex disparity in the disorder, the diverse future trends across different countries, and the potential impact of the Gulf War on ASD trends in Egypt and Saudi Arabia. These findings underscore the need for targeted public health interventions, improved diagnostic practices, and international collaboration to address the growing burden of ASD. Future research should focus on understanding the underlying causes of these trends and developing effective strategies to support individuals with ASD and their families. Declarations Funding This study was funded by National Natural Science Foundation of China (grant number: 82204130), Bethune Project of Jilin University (grant number: 2024B23), Project for Improving Capability of Health Science and Technology in Jilin Province (grant number: 2024A009), and Science and Technology Project of the Education Department of Jilin Province (grant number: JJKH20250209KJ). Author Contribution Jiake Guo: Writing – original draft, Formal analysis. Hongrui Zhang: Writing – original draft. Bin Wang: Writing – original draft. Zhuoshuai Liang: Methodology, Data curation. Xiaoyang Li: Methodology. Ruofei Li: Methodology. Yue Ma: Validation. Lu Chen: Visualization. Yang Yu: Conceptualization. Yuyang Tian: Methodology. Yong Li: Visualization. Yunkai Liu: Funding acquisition. Yi Cheng: Writing – review and editing. Yawen Liu: Writing – review and editing. Yichun Qiao: Project administration. Shuang Qiu: Project administration. Data Availability Data will be made available on request. Ethics approval statement No ethics approval was required for this study. Clinical trial number: not applicable. References Global Burden of Disease Study 2021 Autism Spectrum Collaborators. The global epidemiology and health burden of the autism spectrum: findings from the Global Burden of Disease Study 2021. Lancet Psychiatry. 2025;12:111–21. https://doi.org/10.1016/S2215-0366(24)00363-8 . Buescher AVS, Cidav Z, Knapp M, Mandell DS. Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatr. 2014;168:721–8. https://doi.org/10.1001/jamapediatrics.2014.210 . Vivanti G, Prior M, Williams K, Dissanayake C. Predictors of outcomes in autism early intervention: why don’t we know more? Front Pediatr. 2014;2:58. https://doi.org/10.3389/fped.2014.00058 . Lu Y, Chen L, Meng Y. How do public services supply, livelihood capital, and livelihood strategies affect subjective poverty? PLoS ONE. 2023;18:e0292651. https://doi.org/10.1371/journal.pone.0292651 . Full article. BRICS economic integration: Prospects and challenges. https://www.tandfonline.com/doi/full/10.1080/10220461 .2024.2380676. Accessed 19 Mar 2025. Baxter AJ, Brugha TS, Erskine HE, et al. The epidemiology and global burden of autism spectrum disorders. Psychol Med. 2015;45:601–13. https://doi.org/10.1017/S003329171400172X . Hirvikoski T, Mittendorfer-Rutz E, Boman M, et al. Premature mortality in autism spectrum disorder. Br J Psychiatry J Ment Sci. 2016;208:232–8. https://doi.org/10.1192/bjp.bp.114.160192 . Salomon JA, Haagsma JA, Davis A, et al. Disability weights for the Global Burden of Disease 2013 study. Lancet Glob Health. 2015;3:e712–723. https://doi.org/10.1016/S2214-109X(15)00069-8 . GBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Lond Engl. 2024;403:2162–203. https://doi.org/10.1016/S0140-6736(24)00933-4 . Dou X, Duan G, Zhong Y, et al. The burden of multiple myeloma in China: Trends from 1990 to 2021 and forecasts for 2050. Cancer Lett. 2025;611:217440. https://doi.org/10.1016/j.canlet.2025.217440 . Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19:335–51. https://doi.org/10.1002/(sici)1097-0258(20000215)19:3%3C335::aid-sim336%3E3.0.co;2-z . Lai M-C, Lombardo MV, Ruigrok AN, et al. Quantifying and exploring camouflaging in men and women with autism. Autism Int J Res Pract. 2017;21:690–702. https://doi.org/10.1177/1362361316671012 . Arango C, Dragioti E, Solmi M, et al. Risk and protective factors for mental disorders beyond genetics: an evidence-based atlas. World Psychiatry Off J World Psychiatr Assoc WPA. 2021;20:417–36. https://doi.org/10.1002/wps.20894 . social-development-bulletin- urbanization-sustainable-development-arab-region-english.pdf Autism in Russia. Current Challenges and Support Systems. https://www.totalcareaba.com/autism/autism-in-russia . Accessed 19 Mar 2025. Applied Behavior Analysis. and Autism Spectrum Disorder in the Gulf Region in the Middle East | Journal of Developmental and Physical Disabilities. https://link.springer.com/article/ 10.1007/s10882-023-09931-7 . Accessed 19 Mar 2025. Sun N, Jia X, Shi X, et al. A Global Decomposition Analysis of the Effect of Population Aging on Disability-Adjusted Life Years Associated with Cardiovascular Disease – 204 Countries and Territories, 1990–2021. China CDC Wkly. 2024;6:1004–10. https://doi.org/10.46234/ccdcw2024.209 . Jiang X, Chen X, Su J, Liu N. Prevalence of autism spectrum disorder in mainland china over the past 6 years: a systematic review and meta-analysis. BMC Psychiatry. 2024;24:404. https://doi.org/10.1186/s12888-024-05729-9 . Demographic ageing. health status and life quality of the elderly in Russia | China Population and Development Studies. https://link.springer.com/article/ 10.1007/s42379-023-00133-4 . Accessed 19 Mar 2025. Karim MS. Demographic and Socio-economic Situation in Muslim Countries: A Comparative Analysis. Mohamadi E, Kraemer A, Majdzadeh R, et al. Impacts of economic sanctions on population health and health system: a study at national and sub-national levels from 2000 to 2020 in Iran. Glob Health. 2024;20:81. https://doi.org/10.1186/s12992-024-01084-2 . Lyall K, Croen L, Daniels J, et al. The Changing Epidemiology of Autism Spectrum Disorders. Annu Rev Public Health. 2017;38:81–102. https://doi.org/10.1146/annurev-publhealth-031816-044318 . Gl MBJH W. Does Language Matter? Identity-First Versus Person-First Language Use in Autism Research: A Response to Vivanti. J Autism Dev Disord. 2023;53. https://doi.org/10.1007/s10803-020-04858-w . Additional Declarations No competing interests reported. Supplementary Files SupplementalTables.docx SupplementalFigures.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7626996","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":525038383,"identity":"b36055a1-5dec-47b0-a85b-37fb5667424b","order_by":0,"name":"Jiake Guo","email":"","orcid":"","institution":"School of Public Health of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Jiake","middleName":"","lastName":"Guo","suffix":""},{"id":525038384,"identity":"b1584707-7d14-4cfc-8da2-b8a78db0bc96","order_by":1,"name":"Hongrui Zhang","email":"","orcid":"","institution":"School of Public Health of Jilin 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1","display":"","copyAsset":false,"role":"figure","size":372674,"visible":true,"origin":"","legend":"\u003cp\u003eThe ranking of age-standardized rates in different locations in 1990 and 2021. Comparison of ASD burden across BRICS nations, highlighting changes in prevalence and DALY rates over time.\u003c/p\u003e\n\u003cp\u003eBRICS: Brazil, Russian Federation, India, China, South Africa, Egypt, Ethiopia, Saudi Arabia, Iran, United Arab Emirates.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7626996/v1/70fed7374c7c04c1318246ba.png"},{"id":93107660,"identity":"75ee4ba4-03f1-40b8-aad6-090d43c142aa","added_by":"auto","created_at":"2025-10-09 06:57:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":243633,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence trends of Autism-Spectrum Disorder from 1990 to 2021. Time trends showing the overall increase in ASD prevalence, with AAPC values indicating average annual percent change.\u003c/p\u003e\n\u003cp\u003eASPR: Age-standardized prevalence rate, AAPC: Average Annual Percentage Change, APC: Annual Percentage Change, BRICS: Brazil, Russian Federation, India, China, South Africa, Egypt, Ethiopia, Saudi Arabia, Iran, United Arab Emirates.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7626996/v1/fd123962d49e4e3fb90df1a2.png"},{"id":93107862,"identity":"f1f189a7-4b39-4c11-92a3-f313cf5a9517","added_by":"auto","created_at":"2025-10-09 07:05:45","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":359691,"visible":true,"origin":"","legend":"\u003cp\u003eThe trends of Autism-Spectrum Disorder prevalence among males and females from 1990 to 2021. Prevalence trends by sex, showing consistently higher rates in males across all BRICS countries.\u003c/p\u003e\n\u003cp\u003eASPR: Age-standardized prevalence rate, BRICS: Brazil, Russian Federation, India, China, South Africa, Egypt, Ethiopia, Saudi Arabia, Iran, United Arab Emirates; Error bars indicate the 95% uncertainty level (UI) for the number of cases; Shading indicates the 95% UI for the age-standardized prevalence rate.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7626996/v1/717f985187d0e444c82cfa10.png"},{"id":93107659,"identity":"7005fb79-6341-490a-abb3-60812380357f","added_by":"auto","created_at":"2025-10-09 06:57:45","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":343953,"visible":true,"origin":"","legend":"\u003cp\u003eThe trends of Autism-Spectrum Disorder incidence among males and females from 1990 to 2021. Incidence trends by sex, with error bars indicating 95% uncertainty intervals.\u003c/p\u003e\n\u003cp\u003eASIR: Age-standardized incidence rate, Error bars indicate the 95% uncertainty level (UI) for the number of incidences; Shading indicates the 95% UI for the age-standardized prevalence rate.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7626996/v1/276fd8916a601591bde499b2.png"},{"id":93107680,"identity":"ffd4d7fe-849c-4858-9836-74551595bb55","added_by":"auto","created_at":"2025-10-09 06:57:46","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":414506,"visible":true,"origin":"","legend":"\u003cp\u003eThe trends of Autism-Spectrum Disorder prevalence across all age groups among males and females. Prevalence distribution across age groups, showing peak rates in early childhood and secondary increases after age 30 in some countries.\u003c/p\u003e\n\u003cp\u003eASPR: Age-standardized prevalence rate, BRICS: Brazil, Russian Federation, India, China, South Africa, Egypt, Ethiopia, Saudi Arabia, Iran, United Arab Emirates; Error bars indicate the 95% uncertainty level (UI) for the number of cases; Shading indicates the 95% UI for the age-standardized prevalence rate.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7626996/v1/d1dc9c5887fd61b4b5d8e303.png"},{"id":93107869,"identity":"48313512-3d3c-4287-a29f-57aef95fba04","added_by":"auto","created_at":"2025-10-09 07:05:46","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":250567,"visible":true,"origin":"","legend":"\u003cp\u003eThe projected trends of Autism-Spectrum Disorder prevalence by 2030. Forecasted prevalence using Bayesian Age-Period-Cohort (BAPC) modeling, indicating divergent future trajectories by country and sex.\u003c/p\u003e\n\u003cp\u003eASPR: Age-standardized prevalence rate, BRICS: Brazil, Russian Federation, India, China, South Africa, Egypt, Ethiopia, Saudi Arabia, Iran, United Arab Emirates.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7626996/v1/4f0a66bfc45a4de02e1b2f82.png"},{"id":101284536,"identity":"4fa9c8e5-7a63-404c-82c3-34cb8db9b656","added_by":"auto","created_at":"2026-01-28 06:11:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2439614,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7626996/v1/f0c25b6a-80cb-48c2-b3de-be28c524e128.pdf"},{"id":93107658,"identity":"84ca162f-231f-46c4-9e1a-7a0622f5050e","added_by":"auto","created_at":"2025-10-09 06:57:45","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":24519,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7626996/v1/f955f2e0f81e6a5d0a8f51a9.docx"},{"id":93107692,"identity":"2205b746-3298-46cd-91f9-1eac5e0b2689","added_by":"auto","created_at":"2025-10-09 06:57:47","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":42488407,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalFigures.docx","url":"https://assets-eu.researchsquare.com/files/rs-7626996/v1/c3223b577bc2baf431d30498.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Trends and Burden of Autism Spectrum Disorder in BRICS Countries: A Global Burden of Disease Analysis from 1990 to 2021","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eAutism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in social interaction and communication, as well as repetitive behaviors and restricted interests. Individuals with ASD are usually found in their early childhood. Moreover, it was estimated that, 618,000 individuals (1 in every 127 individuals) are affected by ASD globally[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLong-term of ASD leads to impairment for children with ASD, their families, and society[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The extensive investment of time and energy in caring for individuals with ASD can help reduce the negative impact of autism on families and society[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, social livelihood issues greatly affect the extent of investment of time and energy[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The BRICS countries (Brazil, Russia, India, China, South Africa, Saudi Arabia, Iran, Egypt, Ethiopia, and the United Arab Emirates) are undergoing significant economic and social changes, generating the remarkable increase of social livelihood issues[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Thus, individuals with ASD and the burden of ASD in the BRICS countries should deserve more attention. In this study, we updated cognition for GBD about ASD in individuals in the BRICS countries using data from 1990 to 2021.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Data sources\u003c/h2\u003e\u003cp\u003eThe data used in this study were obtained from the Global Burden of Disease (GBD) 2021 database. The GBD data are publicly accessible through the IHME\u0026rsquo;s online platform (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://vizhub.healthdata.org/gbd-results/\u003c/span\u003e\u003cspan address=\"https://vizhub.healthdata.org/gbd-results/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). GBD 2021 is the only publicly available database that allows ASD comparisons across the ten BRICS countries, yet the validity of its estimates remains contingent on the availability of primary data and cross-cultural differences in diagnostic practices[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The model imposes YLL\u0026thinsp;=\u0026thinsp;0 for ASD, potentially underestimating premature mortality risks[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and GBD has not disclosed the disability weights for ASD or how these are adjusted for comorbidities such as epilepsy or intellectual disability[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Consequently, all DALY figures reported below reflect \u0026ldquo;health loss\u0026rdquo; within the GBD framework and should not be interpreted as a judgment on the inherent value of autistic individuals\u0026rsquo; lives.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Definitions\u003c/h2\u003e\u003cp\u003eThe burden of ASD in the BRICS countries was evaluated using the incidence, prevalence, and DALYs. Prevalence refers to the proportion of the population affected by ASD at a given time. Incidence refers to the proportion of new cases affected by ASD within a specific period of time. All estimates were expressed as counts per thousand and rates per 100,000 population. The 95% uncertainty interval (UI) was calculated from the 2.5th and 97.5th percentiles of an ordered set of 1,000 draws. YLDs were determined by multiplying the prevalence by their corresponding disability weights. YLLs were calculated by multiplying the number of deaths in each age group by remaining life expectancy for that age group. DALYs were obtained by summing YLLs and YLDs. In GBD 2021, the disability weight (DW) assigned to ASD is 0.262 (95% UI 0.175\u0026ndash;0.364), derived from global health surveys without further stratification for the presence or absence of co-occurring conditions[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Age-standardized populations were calculated using the GBD world population age standard. Because in GBD YLL of ASD is zero in GBD, YLDs and DALYs values are identical[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Statistical Analysis\u003c/h2\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.3.1 Join point regression analysis\u003c/h2\u003e\u003cp\u003eTo evaluate trends over time, we employed joinpoint regression analysis using Joinpoint R package. This method was used to analyze trends and identify specific periods of significant change in each country\u0026rsquo;s ASD metrics, and used to calculate the Average annual percent change (AAPC) for the entire time and Annual Percentage Change (APC) for various time segments[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A downward trend was indicated if both the AAPC estimate and its 95% CI upper and lower bounds are lower than 0. These metrics provided a detailed understanding of the shifting epidemiological burden across the BRICS countries. In addition to the APC, age-standardized rates for incidence were calculated for each country. We also compared the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR) and age-standardized DALYs rate (ASDALYR) between males and females to assess sex disparities in the burden of ASD. Data were analyzed using 95% uncertainty intervals (UI) to account for variability and estimate the precision of APC and AAPC.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.3.2 Decomposition analysis\u003c/h2\u003e\u003cp\u003eTo understand the increased disease burden caused by ASD globally over the past 30 years, we used decomposition analysis to quantitatively analyze driving factors (population growth, population aging, epidemiological changes) leading to changes in DALYs. For disease burden, the effect obtained from decomposition analysis refers to the impact of change of a driving factor on the total DALYs when other driving factors are held constant. Moreover, the sum of the effects of all driving factors was equal to the change in DALYs.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e2.3.3 Bayesian age-period-cohort analysis\u003c/h2\u003e\u003cp\u003eThe Bayesian Age-Period-Cohort (BAPC) model is eligible for addressing uncertainty and incorporates past data and probability distributions, thereby being used to estimate future trend of ASD with considerations for age, period, and cohort effects. Thus, we used this model to delineate and forecast the trend of the prevalence of ASD up to 2030. Because there are not the incidence data for ASD across the vast majority of age groups in the GBD database, we did not predict the incidence of ASD.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Trends of ASD in the BRICS\u003c/h2\u003e\u003cp\u003eGBD 2021 estimated that in 1990, the ASPR and ASDALYR of Iran, Egypt, India, China, and Brazil were below the global level. The ASIR of India, Brazil, and China were also below the global level. By 2021, ASPR and ASDALYR of Iran had exceeded the global level and Iran, Egypt, Saudi Arabia, and the United Arab Emirates joined the ranks of countries with ASIR below the global level (Fig.\u0026nbsp;1).\u003c/p\u003e\u003cp\u003eIn terms of change from 1990 to 2021, the number of cases of ASD increased from 18\u0026nbsp;million people to 25\u0026nbsp;million people in the BRICS, corresponding to increase of the ASPR of ASD from 677.18 per 100,000 (95% UI\u0026thinsp;=\u0026thinsp;565.07\u0026ndash;802.10) to 708.47 per 100,000 (95% UI\u0026thinsp;=\u0026thinsp;591.70\u0026ndash;838.76) (AAPC\u0026thinsp;=\u0026thinsp;0.15, 95% CI: 0.14\u0026ndash;0.15). The number of incidences of ASD declined from 467,354.20 to 380,300.95 in the BRICS. DALYs increased from 1990 (3,333,619.00) to 2021 (4,721,012.05) (AAPC\u0026thinsp;=\u0026thinsp;0.16, 95% CI: 0.15\u0026ndash;0.16). Indeed, the ASDALYR of ASD increased from 126.68 per 100,000 (95% UI\u0026thinsp;=\u0026thinsp;86.79\u0026ndash;178.37) in 1990 to 132.84 per 100,000 (95% UI\u0026thinsp;=\u0026thinsp;90.52\u0026ndash;187.10) in 2021. The ASPR and ASDALYR showed enhanced trend in the BRICS. Additionally, compared with other countries in the BRICS, Egypt, the United Arab Emirates, and Saudi Arabia had negative AAPC (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Supplemental Table\u0026nbsp;1, Supplemental Table\u0026nbsp;2).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAge standardized prevalence of ASD and AAPC from 1990 to 2021.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1990\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eAAPC_95%CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber _95%UI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eASPR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNumber _95%UI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eASPR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlobal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e41929995.80(35349447.65, 49633545.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e773.25(648.35, 914.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e61823539.64(52067672.56, 72711237.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e788.31(662.06, 928.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003cp\u003e(0.06,0.06)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBRICS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17734757.69(14836126.94, 20993212.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" 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colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1335516.02(1118732.46, 1591669.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e614.09(512.43, 731.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003cp\u003e(0.03,0.03)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6260915.69(5254093.96, 7405449.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e702.56(587.55, 832.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10120041.83(8503425.42, 11876618.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e708.06(593.06, 833.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003cp\u003e(0.02,0.03)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRussian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1342411.31(1129810.44, 1588282.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e902.13(758.86, 1067.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1286224.88(1079417.25, 1526744.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e928.76(777.35, 1100.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003cp\u003e(0.09,0.09)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouth Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e344036.20(289551.83, 404947.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e892.64(747.46, 1053.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e524999.04(440584.04, 623271.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e911.73(763.79, 1079.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003cp\u003e(0.07,0.07)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEgypt\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e431930.52(360259.26, 514118.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e747.76(619.91, 891.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e827877.45(692545.01, 982172.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e763.69(636.20, 906.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003cp\u003e(0.07,0.07)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSaudi Arabia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e130755.76(109552.59, 155236.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e793.47(660.71, 943.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e316318.99(261845.67, 377151.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e817.80(674.79, 974.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.1\u003c/p\u003e\u003cp\u003e(0.1,0.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIran\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e458912.64(387003.71, 544338.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e771.06(647.63, 913.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e677139.66(567412.62, 799867.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e791.19(661.59, 934.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003cp\u003e(0.08,0.09)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnited Arab Emirates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16389.83(13613.95, 19766.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e833.10(689.75, 1003.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e85810.91(71622.28, 101886.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e840.84(701.50, 1001.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003cp\u003e(0.02,0.04)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEthiopia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e467650.02(394757.10, 550491.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e861.04(721.82, 1017.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1026009.42(860805.03, 1209151.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e894.59(48.12, 1056.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003cp\u003e(0.12,0.13)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eUI: Uncertainty Interval, CI: confidence interval, BRICS: Brazil, Russian Federation, India, China, South Africa, Egypt, Ethiopia, Saudi Arabia, Iran, United Arab Emirates; ASPR: Age-standardized prevalence rate, AAPC: Average Annual Percentage Change.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThere existed the increased trend of ASPR and ASDALYR of ASD in global and the BRICS from 1990 to 2021 (Fig .2, Supplemental Fig.\u0026nbsp;1). The overall ASIR in Egypt, Saudi Arabia, and the United Arab Emirates declined (Supplemental Fig.\u0026nbsp;2). In the BRICS, individuals affected by ASD also exhibit the same gender differences between males and females as observed globally[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Interestingly, United Arab Emirates and Saudi Arabia exhibited similar rapid increasing trend of cases and the number DALYs of ASD from 2005 to 2021. The cases and the number of DALYs of ASD in the Russian Federation have not changed significantly. All countries in the BRICS displayed similar trends of ASPR and ASDALYR (Fig.\u0026nbsp;3, Supplemental Fig.\u0026nbsp;3). China had a similar trend of incidence with Iran, Russian Federation and Saudi Arabia and Egypt had a similar trend of ASIR with South Africa and United Arab Emirates (Fig.\u0026nbsp;4). In 2021, the global cases and the number DALYs of ASD reached their peaks between 5 and 9 years old, and then gradually decreased with increasing age. However, in the BRICS countries, there was a noticeable upward trend after the age of 30, especially in China, Iran, Russia, Saudi Arabia, and the United Arab Emirates (Fig.\u0026nbsp;5, Supplemental Fig.\u0026nbsp;4).\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.2 Aging and epidemiological changes greatly contribute to the change of DALYs of Russian Federation and China\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe used decomposition analyses to investigate the effect of aging, population and epidemiological change on the change of DALYs. Population growth is the main reason for the increase in ASD DALYs. Brazil, India, South Africa, Ethiopia, Iran (Islamic Republic of), Egypt, Saudi Arabia, and United Arab Emirates had relative similar contribution of aging, population and epidemiological change to the change of DALYs. Of note, aging and epidemiological changes had major contribution to the change of DALYs of Russian Federation and China (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe percentage contributions of aging, population, and epidemiological change to the DALYs of ASD from 1990 to 2021.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLocation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall difference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAging (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePopulation (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEpidemiological change (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlobal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3675651.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-281710.89 (-7.66%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3758723.07 (102.26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e198638.90 (5.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBRICS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1387393.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-185569.25 (-13.38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1424125.67 (102.65%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e148836.62 (10.73%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e719006.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-56717.81 (-7.89%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e758526.84 (105.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e17197.76 (2.39%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChina\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e307773.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-93992.09 (-30.54%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e292919.08 (95.17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e108846.13 (35.37%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEthiopia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e105984.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1557.13 (-1.47%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e102466.43 (96.68%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5074.80 (4.79%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEgypt\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e74697.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1504.61 (-2.01%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e74095.29 (99.19%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2106.45 (2.82%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e72441.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-12242.10 (-16.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e82622.22 (114.05%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2061.85 (2.85%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIran\u0026nbsp;(Islamic\u0026nbsp;Republic\u0026nbsp;of)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39589.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-5237.21 (-13.23%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42278.05 (106.79%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2548.95 (6.44%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSaudi\u0026nbsp;Arabia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34415.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-652.98 (-1.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34169.46 (99.29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e898.64 (2.61%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouth\u0026nbsp;Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32812.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-2817.19 (-8.59%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34301.03 (104.54%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1328.65 (4.05%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnited\u0026nbsp;Arab\u0026nbsp;Emirates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12882.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.40 (0.52%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12829.07 (99.58%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-12.64 (-0.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRussian\u0026nbsp;Federation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-12210.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-10914.53 (89.39%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-10081.8 (82.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8786.03 (-71.96%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eASD: Autism Spectrum Disorder, BRICS: Brazil, Russian Federation, India, China, South Africa, Egypt, Ethiopia, Saudi Arabia, Iran, United Arab Emirates; DALYs: Disability adjusted life years.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Anisotropic trends of prevalence of ASD from 2022 to 2030\u003c/h2\u003e\u003cp\u003eDownward trends of ASPR were predicted using BAPC model in Brazil, India, Egypt, and the United Arab Emirates from 2022 to 2030. However, among Brazil, India, Egypt, and the United Arab Emirates, the ASPR in male Brazilian will exhibit an upward trend possibly. By contrast, the age-standardized prevalence will display an upward trend for males and females in China, South Africa, Ethiopia, Iran, and Saudi Arabia. However, ASPR will decline in females of the other BRICS countries except China, South Africa, Ethiopia, Iran, and Saudi Arabia. The ASPR in the Russian Federation will remain stable from 2022 to 2030. (Fig.\u0026nbsp;6)\u003c/p\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eIn this study, we revealed significant trends and differences in the epidemiological burden of ASD in the BRICS, highlighting the necessity for tailored public health interventions and further research.\u003c/p\u003e\u003cp\u003eOver the past three decades, the prevalence and DALYs of ASD in the BRICS have significantly increased: both the ASPR of ASD and the ASDALYR rose from 1990 to 2021. Similarly, the prevalence of ASD has risen dramatically from 1990 to 2021 globally[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The increase in prevalence of the BRICS can be attributed to several factors, including improved diagnostic capabilities and increased awareness of ASD. The changes of environmental and genetic risk factors also contribute to the increasing incidence of ASD[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The rising DALYs documented the significant health burden associated with ASD, emphasizing the need for comprehensive support services and interventions to improve the quality of life for individuals with ASD and their families. Additionally, the social and economic devastation caused by the Gulf War may have led to increased stress levels in pregnant women, further increasing the prevalence and DALYs of ASD in Egypt and Saudi Arabia[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. But at present, no empirical study has established a direct link between prenatal stress during the Gulf War and an increased prevalence of ASD; this hypothesis awaits verification through specifically designed epidemiological research.\u003c/p\u003e\u003cp\u003eFrom 1990 to 2021, the ASPR and ASDALYR of ASD showed a significant upward trend globally[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This trend was also reflected in the BRICS, indicating that the countries except for Russia faced similar challenges in addressing the disease burden. Notably, the United Arab Emirates and Saudi Arabia also exhibited a similar rapid increase in cases and the number DALYs of ASD from 2005 to 2021. Urbanization renders living pressure on people. Indeed, the urbanization in the United Arab Emirates and Saudi Arabia accelerated between 2000 and 2010[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Living pressure of parents is associated with risks of ASD in children. The lack of significant changes in cases and the number of DALYs of ASD in Russian Federation may be due to the low diagnostic and awareness levels[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRegarding the shift of the peak cases and the peak number DALYs of ASD towards higher age groups, the increase of cases and the number DALYs of ASD among individuals over the age of 30 in China, Russia, and Iran could be attributed to the severity of aging. With improvement of awareness and diagnostic, more middle-aged individuals may be diagnosed with ASD. For the United Arab Emirates and Saudi Arabia. For instance, many families in the Gulf Cooperation Council (GCC) believe that an ASD diagnosis is a stigma and, owing to their belief in the will of Allah. Thus, they resist this stigma and refuse to seek medical attention[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], thereby leading to an underestimation of cases and the number DALYs of ASD among young people.\u003c/p\u003e\u003cp\u003eDecomposition analysis is eligible for investigating the factors affecting the changes of DALYs. We found that aging leads to a decrease in ASD DALYs in China, while epidemiological changes lead to an increase in ASD DALYs in China, because aging primarily affects the elderly population, while the peak incidence of ASD is formed in childhood and adolescence. As the proportion of the elderly population increases, the ASDALYR for ASD may relatively decrease owing to the increased share of the elderly in the total population denominator[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Diagnostic capabilities are improved and diagnostic criteria, increasing awareness of ASD in China. Additionally, social development and changes in lifestyle lead to an increase in the DALYs associated with ASD[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Severe population aging[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], combined with its limited diagnostic capabilities and awareness of ASD, may lead to a decrease in the DALYs of ASD in Russia[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Aging contributed less to the change of DALYs in Egypt, United Arab Emirates, and Saudi Arabia, partly owing to high population growth rate of Islamic countries[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. By contrast, aging that contributed greater to the change of DALYs in Iran may be due to economic sanctions[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe GBD 2021 estimates for ASD rely on modelled extrapolations rather than country-specific epidemiological surveys, and their validity is influenced by differences in diagnostic criteria, reporting systems, and comorbidity-coding strategies[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The assumption of YLL\u0026thinsp;=\u0026thinsp;0 overlooks the heightened risk of premature death in individuals with ASD due to unintentional injuries, suicide, or associated comorbidities[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. DALYs and their associated disability weights are regarded by some members of the autistic community as pejorative; this study employs them solely within the GBD technical framework and does not intend to label ASD as a \u0026ldquo;burden\u0026rdquo;[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Any speculation linking the Gulf War to ASD remains hypothetical, as direct evidence connecting prenatal stress during that period to ASD incidence is lacking and should be examined in future ecological or case\u0026ndash;control studies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides a comprehensive analysis of the trends and burden of ASD in the BRICS using the latest data from the Global Burden of Disease 2021. Our findings highlight the increasing prevalence and DALYs of ASD, the significant sex disparity in the disorder, the diverse future trends across different countries, and the potential impact of the Gulf War on ASD trends in Egypt and Saudi Arabia. These findings underscore the need for targeted public health interventions, improved diagnostic practices, and international collaboration to address the growing burden of ASD. Future research should focus on understanding the underlying causes of these trends and developing effective strategies to support individuals with ASD and their families.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis study was funded by National Natural Science Foundation of China (grant number: 82204130), Bethune Project of Jilin University (grant number: 2024B23), Project for Improving Capability of Health Science and Technology in Jilin Province (grant number: 2024A009), and Science and Technology Project of the Education Department of Jilin Province (grant number: JJKH20250209KJ).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJiake Guo: Writing \u0026ndash; original draft, Formal analysis. Hongrui Zhang: Writing \u0026ndash; original draft. Bin Wang: Writing \u0026ndash; original draft. Zhuoshuai Liang: Methodology, Data curation. Xiaoyang Li: Methodology. Ruofei Li: Methodology. Yue Ma: Validation. Lu Chen: Visualization. Yang Yu: Conceptualization. Yuyang Tian: Methodology. Yong Li: Visualization. Yunkai Liu: Funding acquisition. Yi Cheng: Writing \u0026ndash; review and editing. Yawen Liu: Writing \u0026ndash; review and editing. Yichun Qiao: Project administration. Shuang Qiu: Project administration.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData will be made available on request.\u003c/p\u003e\n\u003ch3\u003eEthics approval statement\u003c/h3\u003e\n\u003cp\u003eNo ethics approval was required for this study. Clinical trial number: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGlobal Burden of Disease Study 2021 Autism Spectrum Collaborators. The global epidemiology and health burden of the autism spectrum: findings from the Global Burden of Disease Study 2021. Lancet Psychiatry. 2025;12:111\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S2215-0366(24)00363-8\u003c/span\u003e\u003cspan address=\"10.1016/S2215-0366(24)00363-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBuescher AVS, Cidav Z, Knapp M, Mandell DS. Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatr. 2014;168:721\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jamapediatrics.2014.210\u003c/span\u003e\u003cspan address=\"10.1001/jamapediatrics.2014.210\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVivanti G, Prior M, Williams K, Dissanayake C. Predictors of outcomes in autism early intervention: why don\u0026rsquo;t we know more? Front Pediatr. 2014;2:58. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fped.2014.00058\u003c/span\u003e\u003cspan address=\"10.3389/fped.2014.00058\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLu Y, Chen L, Meng Y. How do public services supply, livelihood capital, and livelihood strategies affect subjective poverty? PLoS ONE. 2023;18:e0292651. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0292651\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0292651\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFull article. BRICS economic integration: Prospects and challenges. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.tandfonline.com/doi/full/10.1080/10220461\u003c/span\u003e\u003cspan address=\"https://www.tandfonline.com/doi/full/10.1080/10220461\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.2024.2380676. Accessed 19 Mar 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaxter AJ, Brugha TS, Erskine HE, et al. The epidemiology and global burden of autism spectrum disorders. Psychol Med. 2015;45:601\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S003329171400172X\u003c/span\u003e\u003cspan address=\"10.1017/S003329171400172X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHirvikoski T, Mittendorfer-Rutz E, Boman M, et al. Premature mortality in autism spectrum disorder. Br J Psychiatry J Ment Sci. 2016;208:232\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1192/bjp.bp.114.160192\u003c/span\u003e\u003cspan address=\"10.1192/bjp.bp.114.160192\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSalomon JA, Haagsma JA, Davis A, et al. Disability weights for the Global Burden of Disease 2013 study. Lancet Glob Health. 2015;3:e712\u0026ndash;723. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S2214-109X(15)00069-8\u003c/span\u003e\u003cspan address=\"10.1016/S2214-109X(15)00069-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990\u0026ndash;2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Lond Engl. 2024;403:2162\u0026ndash;203. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(24)00933-4\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(24)00933-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDou X, Duan G, Zhong Y, et al. The burden of multiple myeloma in China: Trends from 1990 to 2021 and forecasts for 2050. Cancer Lett. 2025;611:217440. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.canlet.2025.217440\u003c/span\u003e\u003cspan address=\"10.1016/j.canlet.2025.217440\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19:335\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/(sici)1097-0258(20000215)19:3%3C335::aid-sim336%3E3.0.co;2-z\u003c/span\u003e\u003cspan address=\"10.1002/(sici)1097-0258(20000215)19:3%3C335::aid-sim336%3E3.0.co;2-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLai M-C, Lombardo MV, Ruigrok AN, et al. Quantifying and exploring camouflaging in men and women with autism. Autism Int J Res Pract. 2017;21:690\u0026ndash;702. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1362361316671012\u003c/span\u003e\u003cspan address=\"10.1177/1362361316671012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArango C, Dragioti E, Solmi M, et al. Risk and protective factors for mental disorders beyond genetics: an evidence-based atlas. World Psychiatry Off J World Psychiatr Assoc WPA. 2021;20:417\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/wps.20894\u003c/span\u003e\u003cspan address=\"10.1002/wps.20894\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003esocial-development-bulletin-\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003eurbanization-sustainable-development-arab-region-english.pdf\u003c/span\u003e\u003cspan address=\"http://urbanization-sustainable-development-arab-region-english.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAutism in Russia. Current Challenges and Support Systems. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.totalcareaba.com/autism/autism-in-russia\u003c/span\u003e\u003cspan address=\"https://www.totalcareaba.com/autism/autism-in-russia\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 19 Mar 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eApplied Behavior Analysis. and Autism Spectrum Disorder in the Gulf Region in the Middle East | Journal of Developmental and Physical Disabilities. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/article/\u003c/span\u003e\u003cspan address=\"https://link.springer.com/article/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10882-023-09931-7\u003c/span\u003e\u003cspan address=\"10.1007/s10882-023-09931-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 19 Mar 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSun N, Jia X, Shi X, et al. A Global Decomposition Analysis of the Effect of Population Aging on Disability-Adjusted Life Years Associated with Cardiovascular Disease \u0026ndash;\u0026thinsp;204 Countries and Territories, 1990\u0026ndash;2021. China CDC Wkly. 2024;6:1004\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.46234/ccdcw2024.209\u003c/span\u003e\u003cspan address=\"10.46234/ccdcw2024.209\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJiang X, Chen X, Su J, Liu N. Prevalence of autism spectrum disorder in mainland china over the past 6 years: a systematic review and meta-analysis. BMC Psychiatry. 2024;24:404. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12888-024-05729-9\u003c/span\u003e\u003cspan address=\"10.1186/s12888-024-05729-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDemographic ageing. health status and life quality of the elderly in Russia | China Population and Development Studies. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/article/\u003c/span\u003e\u003cspan address=\"https://link.springer.com/article/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s42379-023-00133-4\u003c/span\u003e\u003cspan address=\"10.1007/s42379-023-00133-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 19 Mar 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarim MS. Demographic and Socio-economic Situation in Muslim Countries: A Comparative Analysis.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMohamadi E, Kraemer A, Majdzadeh R, et al. Impacts of economic sanctions on population health and health system: a study at national and sub-national levels from 2000 to 2020 in Iran. Glob Health. 2024;20:81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12992-024-01084-2\u003c/span\u003e\u003cspan address=\"10.1186/s12992-024-01084-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLyall K, Croen L, Daniels J, et al. The Changing Epidemiology of Autism Spectrum Disorders. Annu Rev Public Health. 2017;38:81\u0026ndash;102. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1146/annurev-publhealth-031816-044318\u003c/span\u003e\u003cspan address=\"10.1146/annurev-publhealth-031816-044318\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGl MBJH W. Does Language Matter? Identity-First Versus Person-First Language Use in Autism Research: A Response to Vivanti. J Autism Dev Disord. 2023;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10803-020-04858-w\u003c/span\u003e\u003cspan address=\"10.1007/s10803-020-04858-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Autism Spectrum Disorder, Joinpoint, Decomposition analysis, Bayesian age-period-cohort analysis, BRICS, GBD 2021","lastPublishedDoi":"10.21203/rs.3.rs-7626996/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7626996/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAutism Spectrum Disorder (ASD) is a significant neurodevelopmental condition affecting social interaction and communication, with a global prevalence of 1 in 127 individuals. This study aims to update the understanding of ASD burden in BRICS countries (Brazil, Russia, India, China, South Africa, Saudi Arabia, Iran, Egypt, Ethiopia, and the United Arab Emirates) using data from 1990 to 2021. Data from the Global Burden of Disease (GBD) 2021 database were analyzed. Joinpoint regression analysis was used to identify trends and changes in ASD metrics over time. Decomposition analysis quantified the impact of population growth, aging, and epidemiological changes on DALYs. Bayesian age-period-cohort analysis forecasted future trends in prevalence up to 2030. From 1990 to 2021, age-standardized prevalence (ASPR) of ASD in BRICS countries increased from 677.18 to 708.47 per 100,000, while age-standardized DALYs rate (ASDALYR) rose from 126.68 to 132.84 per 100,000. Decomposition analysis showed that population growth was the main driver of increased DALYs, with aging and epidemiological changes significantly impacting Russia and China. Future trends predicted by BAPC model indicated varied trajectories, with China, South Africa, Ethiopia, Iran, and Saudi Arabia still on the rise. The findings highlight the growing burden of ASD in BRICS countries, emphasizing the need for tailored public health interventions and improved diagnostic practices. The study underscores the importance of addressing the social and economic factors influencing ASD prevalence and DALYs. Future research should focus on understanding the underlying causes and developing effective support strategies for individuals with ASD and their families.\u003c/p\u003e","manuscriptTitle":"Trends and Burden of Autism Spectrum Disorder in BRICS Countries: A Global Burden of Disease Analysis from 1990 to 2021","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-09 06:57:40","doi":"10.21203/rs.3.rs-7626996/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"845da1c2-49b7-42ff-8fc8-311c23e1529d","owner":[],"postedDate":"October 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-28T06:11:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-09 06:57:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7626996","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7626996","identity":"rs-7626996","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}