ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1666873
This article is part of the Research TopicReal-World Evidence and its Impact on Sustainable Health Financing, Economics and OutcomesView all articles
Real-world Evidence from a Multi-center Pediatric Network: Greenness Exposure and Autism Spectrum Disorder in Urban China
Provisionally accepted
- 1Chengdu Women and Children's Central Hospital, Chengdu, China
- 2Sichuan University, Chengdu, China
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Childhood autism spectrum disorder (ASD) is a global public health concern and its prevalence is increasing rapidly in developing countries such as China. The mechanism behind ASD development remains unclear. Greenness exposure is reportedly associated with various health outcomes, however, the connection between greenness exposure and ASD is relatively unexplored. We designed a two-stage screening process and conducted city-wide screening for early childhood ASD to investigate the association between greenness exposure and ASD prevalence in a megacity in southwest China. We screened 13,458 children from 0-52 months through 20 local primary care hospitals and the estimated ASD prevalence was 0.55%. We matched greenness exposure, air pollution exposure, and weather condition with ASD diagnosis outcomes based on the study subject's geographic information. Gender (being male) and age (older) were significantly associated with higher odds of being diagnosed with ASD. Though the association between ASD diagnosis and greenness remained statistically non-significant, real-world data may help improve ASD screening methods and guide future studies. Our findings highlight the potential role of real-world environmental and health data in informing sustainable urban and pediatric health policies.
Keywords: Real-world data, Child Development, Greenness exposure, Childhood ASD prevalence, NDVI
Received: 16 Jul 2025; Accepted: 29 Aug 2025.
Copyright: © 2025 Yang, He and Zuoqiu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sophia Zuoqiu, Sichuan University, Chengdu, China
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