Fig. 3

A multistate model to estimate association between ASD and the rate of morbidity progression. a The initial condition, labeled “None,” represents participants with no comorbidities at baseline. Intermediate comorbidity states are color coded as follows: cardiovascular disease/hypertension (CVD/HTN, orange), type 2 diabetes and disorders of lipoprotein metabolism (T2D/DLP, green), and depression/anxiety (DEP/ANX, blue). Each colored arrow indicates a transition, with the color corresponding to the condition diagnosed at the time of transition (e.g., blue arrows indicate transitions to a MH diagnosis). The final state “death” is directly accessible from all other states. The “N” below each comorbidity state indicates the total number of participants who entered that state during the follow-up period. Figures b to d show the hazard ratios (HRs) of the association of ASD with an incident diagnosis of b DEP/ANX, c CVD/HTN, and d T2D/DLP, respectively. X axis shows the number of pre-existing comorbidities. HRs were estimated adjusted for age, sex, Townsend deprivation index, and ethnicity. ASD, autism spectrum disorder; DEP/ANX, depression and anxiety; CVD/HTN, cardiovascular disease/hypertension; T2D/DLP, type 2 diabetes and disorders of lipoprotein metabolism; HR, hazard ratio; CI, confidence interval