RESUMO OBJETIVO Investigar os fatores associados ao diagnóstico precoce do autismo e de outros tipos de transtorno global do desenvolvimento (TGD) de crianças atendidas no Centro de Atenção Psicossocial Infantojuvenil do Sistema Único de Saúde, no período de 2013 a 2019, no Brasil. MÉTODOS Estudo transversal exploratório, com base nos dados do Registro das Ações Ambulatoriais de Saúde (RAAS) do primeiro atendimento de crianças de 1 a 12 anos. Foram estimados o risco relativo bruto (RRb) e ajustado (RRa), e respectivo intervalo de confiança de 95% (IC95%), utilizando o modelo de regressão de Poisson com estimativa de variância robusta. RESULTADOS Das 22.483 crianças incluídas no estudo, a maioria era do sexo masculino (81,9%), residia no mesmo município em que foi diagnosticada (96,8%) e na região Sudeste (57,7%). O diagnóstico precoce foi maior para autismo infantil (RRb= 1,48; IC95% 1,27–1,71), TGD sem designação de subtipo (RRb= 1,55; IC95% 1,34–1,80), outros TGD (RRb= 1,48; IC95% 1,21–1,81) e TGD não especificado (RRb= 1,44; IC95% 1,22–1,69) do que para autismo atípico. As crianças que residiam no mesmo município onde foi realizado o diagnóstico tiveram maior índice de diagnóstico precoce (RRb= 1,31; IC95% 1,10–1,55) do que as demais; bem como aquelas encaminhadas pela atenção básica (RRb= 1,51; IC95% 1,37–1,68) e por demanda espontânea (RRb= 1,45; IC95% 1,31–1,61) do que as oriundas de outros tipos de encaminhamento. O diagnóstico precoce foi maior a partir de 2014 e menor na região Norte quando comparada às demais. Na análise múltipla, a magnitude do RRafoi similar ao do RRb. CONCLUSÕES A identificação precoce de autismo e outros TGD tem melhorado no país, mas ainda representa cerca de 30% dos diagnósticos realizados. As variáveis incluídas no modelo foram significativas, mas ainda explicam pouco do diagnóstico precoce de crianças com autismo e outros TGD. (TGD 201 2019 Brasil exploratório RAAS (RAAS anos RRb (RRb RRa, RRa , (RRa) 95 IC95%, IC95 IC (IC95%) robusta 22483 22 483 22.48 estudo 81,9%, 819 81,9% 81 9 (81,9%) 96,8% 968 96 8 (96,8% 57,7%. 577 57,7% . 57 7 (57,7%) RRb= 1,48 148 48 1,27–1,71, 127171 1,27–1,71 27 71 1,27–1,71) 1,55 155 55 1,34–1,80, 134180 1,34–1,80 34 80 1,34–1,80) 1,21–1,81 121181 21 1,44 144 44 1,22–1,69 122169 69 atípico 1,31 131 31 1,10–1,55 110155 10 demais 1,51 151 51 1,37–1,68 137168 37 68 1,45 145 45 1,31–1,61 131161 61 encaminhamento múltipla país 30 realizados significativas 20 (RRa IC9 (IC95% 2248 2 22.4 81,9 (81,9% 96,8 (96,8 57,7 5 (57,7% 1,4 14 4 12717 1,27–1,7 1,5 15 13418 1,34–1,8 3 1,21–1,8 12118 1,22–1,6 12216 6 1,3 13 1,10–1,5 11015 1,37–1,6 13716 1,31–1,6 13116 (IC95 224 22. 81, (81,9 96, (96, 57, (57,7 1, 1271 1,27–1, 1341 1,34–1, 1,21–1, 1211 1,22–1, 1221 1,10–1, 1101 1,37–1, 1371 1,31–1, 1311 (IC9 (81, (96 (57, 127 1,27–1 134 1,34–1 1,21–1 121 1,22–1 122 1,10–1 110 1,37–1 137 1,31–1 (IC (81 (9 (57 1,27– 1,34– 1,21– 1,22– 1,10– 11 1,37– 1,31– (8 ( (5 1,27 1,34 1,21 1,22 1,10 1,37 1,2 1,1
ABSTRACT OBJECTIVE To investigate the factors associated with the early diagnosis of autism and other types of pervasive developmental disorder (PDD) in children treated at the Psychosocial Care Center for Children and Adolescents of the Unified Health System, from 2013 to 2019,in Brazil. METHODS An exploratory cross-sectional study, based on data from the Record of Outpatient Health Actions (RAAS) of the first appointment of children aged 1 to 12 years. The gross (RRg) and adjusted (RRa) relative risks and respective 95% confidence intervals (95%CI) were estimated using the Poisson regression model with robust variance estimation. RESULTS Of the 22,483 children included in the study, the majority were male (81.9%), lived in the same municipality where they were diagnosed (96.8%) and in the Southeast region (57.7%). Early diagnosis was higher for childhood autism (RRg = 1.48; 95%CI 1.27–1.71) , PDD without subtype designation (RRg = 1.55; 95%CI 1.34–1.80), other PDD (RRg = 1.48; 95%CI 1.21–1.81) and PDD not otherwise specified (RRg = 1.44; 95%CI 1.22–1.69) than for atypical autism. Children residing in the same municipality where the diagnosis was made had a higher rate of early diagnosis (RRg = 1.31; 95%CI 1.10–1.55) than the others; as well as those referred by primary care (RRg = 1.51; 95%CI 1.37–1.68) and by spontaneous demand (RRg = 1.45; 95%CI 1.31–1.61) than those from other types of referral. Early diagnosis was higher from 2014 and lower in the North region than in the other regions. In the multiple analysis, the magnitude of RRa was similar to that of RRg. CONCLUSIONS Early identification of autism and other PDD has improved in Brazil, but it still represents about 30% of the diagnoses made. The variables included in the model were significant, but still explain little of the early diagnosis of children with autism and other PDD. (PDD System 201 2019in 2019 Brazil crosssectional cross sectional study RAAS (RAAS years RRg (RRa 95 95CI CI (95%CI estimation 22483 22 483 22,48 81.9%, 819 81.9% 81 9 (81.9%) 96.8% 968 96 8 (96.8% 57.7%. 577 57.7% . 57 7 (57.7%) 1.48 148 48 1.27–1.71 127171 27 71 1.55 155 55 1.34–1.80, 134180 1.34–1.80 34 80 1.34–1.80) 1.21–1.81 121181 21 1.44 144 44 1.22–1.69 122169 69 1.31 131 31 1.10–1.55 110155 10 others 1.51 151 51 1.37–1.68 137168 37 68 1.45 145 45 1.31–1.61 131161 61 referral regions analysis 30 significant 20 2248 2 22,4 81.9 (81.9% 96.8 (96.8 57.7 5 (57.7% 1.4 14 4 1.27–1.7 12717 1.5 15 13418 1.34–1.8 3 1.21–1.8 12118 1.22–1.6 12216 6 1.3 13 1.10–1.5 11015 1.37–1.6 13716 1.31–1.6 13116 224 22, 81. (81.9 96. (96. 57. (57.7 1. 1.27–1. 1271 1341 1.34–1. 1.21–1. 1211 1.22–1. 1221 1.10–1. 1101 1.37–1. 1371 1.31–1. 1311 (81. (96 (57. 1.27–1 127 134 1.34–1 1.21–1 121 1.22–1 122 1.10–1 110 1.37–1 137 1.31–1 (81 (9 (57 1.27– 1.34– 1.21– 1.22– 1.10– 11 1.37– 1.31– (8 ( (5 1.27 1.34 1.21 1.22 1.10 1.37 1.2 1.1