Background: 
There has been recent interest in the relationship between socioeconomic status,urbanicity level and the diagnosis of autism in children. Studies in the United Stateshave found lower rates of autism diagnosis associated with lower socioeconomicstatus, while studies in other countries report no association, or the opposite. In alarge Danish register-based cohort the urbanicity level was critical, with an earlierage of ASD diagnosis in urban areas. No specific studies on the socioeconomicfactors and urban context associated with the age at ASD diagnosis have beenconducted in Italy. Since a diagnostic delay may depend on a heterogeneousfunctioning of the local health care systems in term of waiting times, a more specificconnection for our targets of interest is the age at first medical contact fordiagnostic suspicion rather than age at diagnosis. 

Objectives: 
The focus of this pilot study is the association between age at first medical contactfor diagnostic suspicion and socioeconomic status and urbanicity level in LombardyRegion, the most populous and rich Region in Italy. 

Methods: 
Twenty ASD cases referred to our Institute for rehabilitation from 2020 to 2021coming from 16 municipalities were entered in the study. The age at first medicalcontact for parental concern was determined from parents reports. Familysocioeconomic status was calculated from four factor index of social status (motherand father education achievement level and occupation level). Age and place of birthof parents (North, Centre, South Italy) and city size where the family lived, and childgender were other variables used for input data. 

Results: 
The study group was composed by 12 males and 8 females (mean age 7.19 yrs;range 2-11 yrs) diagnosed with autism according to DSM V criteria. The age at firstmedical contact for parental concern ranged between 13 and 79 months (mean=32.8 months) while the age at diagnosis ranged between 23 and 91 months (mean=43 months). The delta time between these two ages was in mean 10 months with apeak of 42 months. Family socioeconomic status index ranged from 4 to 15 (mean=10.25). Correlations between age at first access and study variables are shown intable 1. Mother education years, family SES and father education years being thevariables with the highest inverse correlation(R= -45; - 0.43; -0.41 respectively)resulted the most important factors for an early diagnostic suspicion. 

Conclusions: 
Higher mother and father education years and higher family socioeconomic status,play a substantial role in influencing positively the decision to seek medical help forASD suspicion and consequently the age at diagnosis, while city size has a minorrole.

Notes:

1 - Villa Santa Maria Foundation Autism Research Unit, Tavernerio (Como), Italy