More Diabetes, More Heart Disease: The Physical Health Gap for Autistic Adults

Autistic adults are more likely than non-autistic adults to live with diabetes, heart conditions and other long-term physical illnesses. The pattern appears in health records and surveys from the US, Canada, England, the Netherlands, Denmark, Sweden and Taiwan. Research points to possible contributors that services can act on, from missed screening and medication side effects to poor sleep, stress and poverty, though none has been shown to explain the gap on its own.

In ordinary life, the gap looks like this. It is the autistic adult whose raised blood sugar is found years late, because every appointment was a battle to book. It is the young person whose weight climbs on a medicine that nobody reviews. It is the person who never has the screening test they were invited to, because the phone call, the waiting room and the examination were each one barrier too many. Most of these conditions can be treated, and many can be prevented or caught early. That makes the figures below a question about care, not a verdict on autistic people.

The same pattern in health records and surveys from seven countries

In 2015, researchers at Kaiser Permanente Northern California, a US health plan, noted that “very little is known about the general health status of adults with autism”. Comparing 1,507 autistic adult members with 15,070 matched on sex and age (2008–12), they found “nearly all medical conditions were significantly more common”, including immune conditions, obesity, dyslipidaemia (unhealthy levels of blood fats such as cholesterol), high blood pressure and diabetes. They called for research into “the social, healthcare access, and biological factors” behind this^[4]. Later studies, in different health systems, point the same way.

Designs, comparison groups and measures differ, so the rows are not directly comparable. The Dutch and Danish cohorts include children and adolescents.

England’s survey, sent to a random sample of GP patients, shows how broad the gap is. After adjustment, adults who self-reported as autistic had 2.19 times the odds of a heart condition and 4.25 times the odds of a stroke affecting daily life^[2].

Some of the widest gaps have their own articles. In US Medicare data, epilepsy was recorded for 26.4% of autistic adults aged 65 and over, against 1.9% of a matched group^[11]; see autism and epilepsy. Gut symptoms are covered in gut health and autism.

Diabetes and heart conditions: some of the clearest gaps, arriving earlier

The most comprehensive summary we found is a 2023 meta-analysis of 34 studies (276,173 autistic and 7,733,306 non-autistic participants, children and adults, average age 31). It found raised risks of diabetes (1.57 times), especially type 2 diabetes (2.47 times, from three studies), of dyslipidaemia and of heart disease, but no statistically significant rise for high blood pressure or stroke. The pooled figures mix ages: in the authors’ meta-regression, the associated risk of diabetes and high blood pressure was greater for autistic children than for autistic adults. The authors said this “should prompt clinicians to vigilantly monitor individuals with autism”^[1].

The largest cohort so far, according to its authors, followed 8,690,286 people aged 12 to 65 in the Netherlands from 2014 to 2020. Autism was linked with 1.20 times the hazard of a first cardiometabolic condition, including 1.22 for diabetes, 1.23 for stroke and 1.28 for heart failure. The links appeared in adolescents and in young and middle-aged adults, “but not older individuals (41–65 years), indicating earlier onset”^[6].

That earlier onset shows up elsewhere. In Taiwan, autistic young adults had 5.31 times the hazard of developing type 2 diabetes (adolescents 2.71 times) compared with matched peers, after adjusting for demographics, other conditions and antipsychotic use^[9]. In Ontario, autistic 18- to 24-year-olds had 2.78 times the odds of diabetes and 2.03 times the odds of high blood pressure of peers with no developmental disability, after adjusting for age, sex, rurality and neighbourhood income^[5].

Later in life the gaps persist. In Sweden, autistic adults followed from 45 had 1.89 times the hazard of heart failure and 2.96 times that of glucose dysregulation compared with non-autistic adults, risks that “mainly persisted regardless of intellectual disability or sex”^[8]. In US Medicare data for 2016–17, heart disease was recorded for 54.2% of autistic adults aged 65 and over, against 37.1% of a matched group^[11]. See growing older as an autistic person.

Heart rhythm is a less-studied signal. In the international online survey, autistic women had 2.93 times and autistic men 3.09 times the odds of reporting an arrhythmia (irregular heartbeat) compared with non-autistic women and men, after adjusting for demographics, body mass index, smoking and alcohol^[10]. The sample was self-selected, and the authors warn that its size could inflate the odds ratios.

Weight, breathing and immune conditions: raised, but less consistent

Weight. A 2026 meta-analysis of 62 studies found autistic adults had 1.72 times the odds of obesity (eight studies) and, from three studies, 2.14 times the odds of being underweight^[12]. Weight differences run in both directions.

Breathing. In England, 16.1% of survey respondents who self-reported as autistic reported a breathing condition such as asthma or COPD, against 11.2% of others (adjusted odds 1.91 times higher)^[2]. In Denmark, 41.5% of autistic people had a respiratory diagnosis by age 30, against 34.5% of a random sample^[7]. Asthma alone is less clear: raised among autistic women but not men in the international survey^[10], modestly raised in Ontario (24.42% vs 20.59%)^[5], and not more prevalent according to an umbrella review of 24 systematic reviews^[13].

Immune conditions. Immune conditions were more common in the Kaiser study^[4], and the umbrella review found autoimmune disorders and atopy (allergic conditions) more prevalent. But it called the evidence base “slim”: only one of its 24 reviews was about adults alone^[13].

Prevention reaches autistic adults unevenly

These conditions are easiest to treat when found early, so screening matters, and the picture is more mixed than often assumed. In Kaiser Permanente’s 2012 records, autistic adults were more likely than the general-population group to have had a flu vaccination (43.7% vs 23.1%) and cholesterol and diabetes screening. Breast screening did not differ. Cervical screening was lower: 20.3% vs 29.2% (adjusted odds ratio 0.6)^[3].

A 2026 analysis of records for more than 6 million US adults newly eligible for cancer screening in 2022–24 found wider gaps. Patients diagnosed with autism had a 35.6% lower likelihood of on-time screening, and 50.7% lower for cervical screening. Colorectal screening was the exception (12.1% higher), alongside more use of at-home stool tests: 46.2% of their colorectal screenings, against 37.6%^[14]. This is a research brief from the records company Epic, not a peer-reviewed paper.

In an online survey of 437 adults by a US academic–community partnership, autistic participants reported about half the odds of tetanus vaccination and of Pap smears^[15]. Why these gaps open is covered in barriers to healthcare for autistic adults.

Records also miss what is never diagnosed. In UK primary care records (2000–19) for more than 22,000 autistic adults, new diagnoses of neck or back pain were less common than among matched patients (incidence rate ratio 0.88 for those without an intellectual disability and 0.49 for those with one). The authors suggest possible “under-diagnosis of common conditions in autistic people, particularly those with intellectual disability”^[16].

In England, the NHS annual health check is for people aged 14 and over on a GP learning disability register, and the NHS Health Check for heart disease, stroke and kidney disease risk starts at 40^[17]. Yet the Dutch data suggest cardiometabolic conditions start earlier in autistic people^[6].

What sits behind the gap: medication, sleep, stress and money

None of these studies shows that autism itself causes diabetes or heart disease, or rules out shared biology. They do point to possible contributors that can be changed, though how much each matters has not been measured.

• Medication side effects. In Taiwan, atypical antipsychotic use was associated with type 2 diabetes (hazard ratios 1.97 for short-term and 1.64 for long-term use), yet the autism gap remained after adjusting for it^[9]. In a US study of 545 autistic adults without an intellectual disability, recruited through the SPARK research cohort, antipsychotic use was associated with diabetes^[18]. Medication appears to be part of the picture, not all of it.
• Sleep. In the same US study, 73.2% of participants were classed as overweight or obese. Poorer sleep was linked with more cardiovascular risk factors and with overweight or obesity^[18]. See sleep and autism.
• Stress. A 2026 review notes that autistic people “experience disproportionate chronic stressors in the form of lifelong stigma, victimization, rejection, and a reliance on camouflaging autistic traits”. Few studies have tested stress as a pathway, and the evidence so far “is mixed”^[19].
• Money and work. In England’s survey, adults who self-reported as autistic were 8.7 percentage points more likely to live in the most deprived fifth of neighbourhoods and 19.7 points more likely to be permanently sick or disabled. The raised odds of long-term conditions held after adjusting for area deprivation, which cannot capture individual income^[2].
• Lifestyle is not the whole story. The WHO points to “behavioural risk factors such as physical inactivity” and diet^[20]. But in the international survey, autistic women’s raised odds of heart, breathing and blood-sugar conditions held after adjusting for body mass index, smoking and alcohol^[10].

What the evidence asks of us

The WHO is clear that autistic people “require accessible health services for general health-care needs like the rest of the population, including promotive and preventive services and treatment of acute and chronic illness”^[20]. The evidence suggests what that means in practice.

• Health checks built around autistic adults. England’s national autism strategy for 2021 to 2026 committed to trialling “a primary care health check for autistic adults in the North East”^[21]. In an evaluation of a co-designed check delivered within a randomised trial in Northern England, autistic people, carers and clinicians reported it to be “acceptable, valued and beneficial”, and the evaluators called for “adequate resources, staff training, and integration into care systems”^[22]. We found no published results yet on health outcomes. Funders should make sure that answer arrives.
• Earlier checks for heart and blood-sugar problems. The Dutch researchers say their results “underscore the need for monitoring and treatment of cardiometabolic conditions among individuals with autism”^[6]. Checks that begin at 40 may come too late for some.
• Medicines reviewed and monitored. The SPARK researchers call for “closely monitoring CVD risk factors among autistic adults who use antipsychotic medications”^[18]. That is a job for prescribers and services.
• Tests people can manage. Home testing kits, longer appointments and quieter settings are adjustments, not favours. The colorectal data suggest home testing, at least, may help^[14].
• Better detection. The UK records team concludes that “improved detection should be a clinical and policy priority to reduce health inequalities”^[16].
• Research on the people least studied. Online surveys leave out many autistic adults with an intellectual disability^[10], few systematic reviews focus on adults alone^[13], and almost none of this evidence comes from low- and middle-income countries.

How these conditions feed into shorter lives is covered in autism, mortality and life expectancy. Most are conditions that health services already know how to find and treat. More evidence is in the Autism & Health research library.

Language: this piece uses identity-first language (“autistic people”), the preference of most autistic-led organisations, and uses clinical terms such as “autism spectrum disorder” only when naming a study or diagnostic category.

Why we're publishing this

Health Insurance UK is a commercial health-insurance resource, not a charity and not a campaign. We compiled this evidence because autistic people, their families and the autistic-led organisations pushing for better care deserve the physical health data clean, current and in one place, ready to put in front of a GP practice, a commissioner or a funder. The case belongs to the community living it. Our part is to stand alongside it and say plainly what the figures show: autistic adults live with more long-term illness, much of it the kind that routine, well-adjusted care exists to prevent and treat.

How to read this data

Health records and registers (Kaiser Permanente, Ontario, the Netherlands, Denmark, Sweden, Taiwan, UK primary care, US Medicare) are large, but count only diagnosed autism and diagnosed conditions, and people with a recorded autism diagnosis may have higher support needs than autistic people overall. Surveys (England’s GP Patient Survey, the international survey, SPARK) rely on self-report; the international survey was self-selected and mostly UK-based. Meta-analyses pool studies that often vary a lot, and the 2023 cardiometabolic meta-analysis includes children.

An odds ratio (“times the odds”) is not a hazard ratio (“times the hazard”, the rate of new cases over time) or a relative risk, and for common conditions odds ratios overstate the difference in risk. Adjustment matters: in the GP Patient Survey, autistic respondents were much younger, so their raw rates of diabetes and high blood pressure were lower than other adults’. The higher odds appeared only after adjusting for age and other factors^[2]. Intellectual disability also shapes the figures: 32.5% of autistic survey respondents reported a learning disability^[2], and over 43% of the autistic Medicare group had an intellectual disability^[11]. Nearly all the evidence comes from high-income countries. These are associations, not proof of cause.

Use this data

Free to cite with attribution to Health Insurance UK. Charities, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research for general information. It is not medical advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else’s health, please speak to a qualified health professional.

Sources

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