Quel est le ratio homme-femme dans le "trouble du spectre de l'autisme"? Une revue systématique et une méta-analyse

Aperçu: G.M.

Cinquante-quatre études ont été analysées, avec 13 784 284 participants, dont 53 712 avaient un  TSA (43 972 garçons et 9 740 filles).

La mesure de résultat combinée était le rapport de cote entre hommes et femmes (MFOR), à savoir la probabilité d'être masculin dans le groupe avec TSA par rapport à un groupe non-TSA. En effet, il s'agit du rapport TSA masculin-féminin, qui contrôle le rapport homme-femme entre les participants sans TSA. 

Le MFOR combiné global était de 4,20 (IC 95%: 3,84 à 4,60), mais il y avait une variabilité entre les études très importante (I2 = 90,9%). Les études de haute qualité avaient un MFOR inférieur (3,32; IC à 95%: 2,88 à 3,84). Les études qui ont examiné la population en général pour identifier les participants, indépendamment qu'ils aient déjà eu un diagnostic de TSA, ont montré un MFOR inférieur (3,25; IC à 95%: 2,93-3,62) comparé aux études qui ont seulement déterminé les participants avec un diagnostic TSA préexistant (MFOR 4,56; 95 % CI 4.10-5.07). 

J Am Acad Child Adolesc Psychiatry. 2017 Jun;56(6):466-474. doi: 10.1016/j.jaac.2017.03.013. Epub 2017 Apr 5.

What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis

Loomes R¹, Hull L¹, Mandy WPL².

Author information

1

University College London, UK.

2

University College London, UK. Electronic address: w.mandy@ucl.ac.uk.

Abstract

OBJECTIVE:

To derive the first systematically calculated estimate of the relative proportion of boys and girls with autism spectrum disorder (ASD) through a meta-analysis of prevalence studies conducted since the introduction of the DSM-IV and the International Classification of Diseases, Tenth Revision.

METHOD:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The Medline, Embase, and PsycINFO databases were searched, and study quality was rated using a risk-of-bias tool. Random-effects meta-analysis was used. The pooled outcome measurement was the male-to-female odds ratio (MFOR), namely the odds of being male in the group with ASD compared with the non-ASD group. In effect, this is the ASD male-to-female ratio, controlling for the male-to-female ratio among participants without ASD.

RESULTS:

Fifty-four studies were analyzed, with 13,784,284 participants, of whom 53,712 had ASD (43,972 boys and 9,740 girls). The overall pooled MFOR was 4.20 (95% CI 3.84-4.60), but there was very substantial between-study variability (I² = 90.9%). High-quality studies had a lower MFOR (3.32; 95% CI 2.88-3.84). Studies that screened the general population to identify participants regardless of whether they already had an ASD diagnosis showed a lower MFOR (3.25; 95% CI 2.93-3.62) than studies that only ascertained participants with a pre-existing ASD diagnosis (MFOR 4.56; 95% CI 4.10-5.07).

CONCLUSION:

Of children meeting criteria for ASD, the true male-to-female ratio is not 4:1, as is often assumed; rather, it is closer to 3:1. There appears to be a diagnostic gender bias, meaning that girls who meet criteria for ASD are at disproportionate risk of not receiving a clinical diagnosis.

Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

PMID: 28545751

DOI: 10.1016/j.jaac.2017.03.013

Secular trend of sex ratio and symptom patterns among children with autism spectrum disorders

Traduction partielle: G.M.

Glob Adv Health Med. 2014 May;3(3):92-101. doi: 10.7453/gahmj.2014.028.

Tendance séculaire du sex-ratio et profils de symptômes chez les enfants avec des troubles du spectre autistique

Baker SM¹, Milivojevich A², Kraycar T³, Holt B⁴, Gade S⁵.

• ¹Autism360, Scarsdale, New York (Dr Baker), United States.
• ²The Knowledge Management Group, Mississauga, Ontario (Mr Milivojevich), Canada.
• ³East Hampton Union Free School District, New York (Ms Kraycar), United States.
• ⁴Reingold, Inc, Alexandria, Virginia (Mr Holt), United States.
• ⁵Autism360, Scarsdale, New York (Ms Gade), United States.

Abstract

An information technology invention embodied in a website serving the interests of the autism community was designed to "let the data talk." By its use, the authors have detected a downward temporal trend in 2013 in the sex ratio of 2431 members of Autism360.org from a yearly average between 2010 and 2012 of 4.24 to 3.01 in 2013. 
Une invention en technologie de l'information incorporée dans un site Web servant les intérêts de la communauté de l'autisme a été conçue pour «laisser parler de données." 
 Par son utilisation, les auteurs ont détecté une tendance temporelle à la baisse en 2013 dans le rapport de masculinité de 2431 membres de Autism360.org d'une moyenne annuelle de 04.24 entre 2010 et 2012  à 03.01 en 2013. 
As of the first two months of 2014, the average sex ratio is 2.69. 
Pour les six premiers mois de 2014, la moyenne du sexe ratio est de 2,69.

We report contemporaneous changes in previously reported male vs female symptom patterns. Such changes suggest a convergence in which distinctive severity of certain grouped central nervous, emotional, and immune profile items in females have diminished toward that of males. The data also show correlations among these profile items that add further credence to the sex ratio findings. A wider dispersion of the female data as compared with the male data was found in the year preceding the downward trend in the mean sex ratio. The authors suggest that such a trend toward an increase in the variance of the data points to instability in the biological system-the autism spectrum. We conclude that public policy would be better served by monitoring changes in the standard deviation as compared with the mean in large data sets to better anticipate changes.
The findings we report raise questions based on known sex differences in detoxification chemistry. One such question would be whether maternal, fetal, or individual exposure to a novel environmental factor may have breached the taller fence of female protection from toxins. 
Les résultats que nous rapportons soulèvent des questions sur la base de différences de sexe connus en chimie de désintoxication. Une question serait de savoir si l'exposition individuelle maternelle ou fœtale à un nouveau facteur environnemental peut avoir enfreint la haute protection de la barrière de protection des femmes contre les toxines.

PMID 24944876