Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Center for Urban Population Health, Milwaukee, Wisconsin, USA.
Int J Psychiatry Med. 2010;40(4):363-82. doi: 10.2190/PM.40.4.a.
To perform a novel geographic analysis of Attention-Deficit/ Hyperactivity Disorder (ADHD) diagnosis in Midwest United States.
Primary care children age 5-17 with ADHD diagnosis (N = 6833; 13.5%) were compared to those receiving well child care without ADHD diagnosis (N = 43,630) in a Wisconsin integrated medical system. Street addresses, demographic, and block group level U.S. Census 2000 data were mapped and analyzed using ArcGIS, CrimeStat III, and SaTScan. Lead levels from a State database were linked to 2,837 subjects. Univariate analysis was done by chi-square test or Mann-Whitney U test, multivariate analysis by logistic regression.
ADHD cases were 74% male (p = 0.0001), and more frequently diagnosed in White children (17.3%) than Blacks (10.6%), Hispanics (9.4%), or Asians (3.7%; all p values < 0.001). Overall, male gender, white race, lower block group median household income and population density, and greater distance to nearest park and airport were more predictive of ADHD (p values < 0.001). In urban Milwaukee County (865 cases/10,493 controls) male gender, white race, suburban residence, and younger age were more predictive of ADHD (p values < 0.01). Among children with ADHD diagnosis and linked lifetime lead values, those with a maximum level of 10 microg/dl or more differed significantly from controls (9.3% vs. 5.6%; p = 0.003); elevated lead remained a significant predictor of ADHD diagnosis in multivariate analysis.
Further studies are needed to determine if geographic distribution of ADHD diagnosis can be partially explained by differential efficiency of referral for diagnosis by school districts, by race/ethnicity, and/or built environment.
对美国中西部地区注意力缺陷多动障碍（ADHD）诊断进行新的地理分析。
在威斯康星州综合医疗系统中，对接受 ADHD 诊断的 5-17 岁儿童（N=6833，占 13.5%）和接受儿童保健但无 ADHD 诊断的儿童（N=43630）进行比较。使用 ArcGIS、CrimeStat III 和 SaTScan 对街道地址、人口统计学和街区组级别的美国 2000 年人口普查数据进行映射和分析。将来自州数据库的铅含量与 2837 名受试者进行关联。使用卡方检验或曼-惠特尼 U 检验进行单变量分析，使用逻辑回归进行多变量分析。
ADHD 患者中男性占 74%（p=0.0001），白人患者（17.3%）比黑人（10.6%）、西班牙裔（9.4%）或亚裔（3.7%）更多被诊断为 ADHD（所有 p 值均<0.001）。总体而言，男性、白人、街区组家庭收入中位数和人口密度较低、距离最近公园和机场较远与 ADHD 更相关（p 值均<0.001）。在密尔沃基县市区（865 例病例/10493 例对照）中，男性、白人、郊区居住和年龄较小与 ADHD 更相关（p 值均<0.01）。在 ADHD 诊断并关联了终生铅含量的儿童中，最大铅含量为 10 μg/dl 或更高的儿童与对照组有显著差异（9.3%对 5.6%；p=0.003）；多元分析显示，铅含量升高仍然是 ADHD 诊断的一个显著预测因素。
需要进一步研究以确定 ADHD 诊断的地理分布是否可以部分解释为学区、种族/民族和/或建筑环境对诊断的转诊效率不同。
