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Joe M. Braun, MSPH, RN; Amy Kalkbrenner, MPH

Arch Pediatr Adolesc Med. 2009;163(5):492.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In their article, Waldman et al¹ present a novel hypothesis that examines the association between autism and environmental factors using ecologic data from California, Oregon, and Washington. Their findings suggest a positive association between mean annual precipitation and autism prevalence at the county level. Although the authors address confounding, we believe they should have better addressed the potential effect of confounding by county-level urbanicity and the potential for cross-level bias (ecologic fallacy) when interpreting their results.

First, inadequate control for urbanicity may have confounded the county-level estimates. Most of the counties with the highest prevalence of autism and annual precipitation are also the most populated counties. Weiss² has noted that agencies in the western parts of Oregon and Washington may have identified a greater proportion of children with autism than their eastern counterparts. Urbanicity has a strong association with autism at the . . . [Full Text of this Article]

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RELATED ARTICLE

Autism Prevalence and Precipitation Rates in California, Oregon, and Washington Counties
Michael Waldman, Sean Nicholson, Nodir Adilov, and John Williams
Arch Pediatr Adolesc Med. 2008;162(11):1026-1034.
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RELATED LETTER

Autism Prevalence and Precipitation: The Potential for Cross-Level Bias—Reply
Michael Waldman and Sean Nicholson
Arch Pediatr Adolesc Med. 2009;163(5):492-493.
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