Eworuke Efe, Zeng Qian Ya Lensa, Winterstein Almut G
Department of Epidemiology, Colleges of Medicine and Public Health and Health Professions, University of Florida, Gainesville, FL (AGW).
Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL (EE, QYLZ, AGW).
Psychosomatics. 2015 Sep-Oct;56(5):495-503. doi: 10.1016/j.psym.2014.09.001. Epub 2014 Sep 6.
There is scarce evidence on the epidemiology of attention-deficit/hyperactivity disorder (ADHD) in patients with cystic fibrosis (CF).
We employed stepwise logistic regression to examine the association between ADHD diagnosis and selected patient characteristics.
This was a cross-sectional analysis of inpatient and outpatient billing data for Medicaid beneficiaries with CF ages 3-18 years to obtain ADHD diagnosis prevalence and incidence estimates from 1999-2006.
Annual ADHD prevalence increased 1.55-fold from 5.26% (95% CI: 5.25-5.27) to 8.16% (8.15-8.17), and annual ADHD incidence rose slightly from 1.70% (1.70-1.71) to 2.01% (2.00-2.01). As in the general population, males were significantly more likely to have a diagnosis of ADHD compared with females (odds ratio: 1.97 [CI: 1.49-2.60]), as were children with recent diagnoses of anxiety, emotional disorder, depression, adjustment disorder, and learning, motor, and communication disorders. Patients with ADHD diagnoses were also more likely to be in foster care (odds ratio = 4.36 [CI: 2.26-8.40]). Except for recent DNase use (odds ratio = 0.64 [CI: 0.43-0.93]), CF severity indicators and medications including pancreatic enzymes, inhaled tobramycin, inhaled or oral corticosteroids, inhaled bronchodilators, and oral antibiotics had no association with ADHD diagnosis.
ADHD prevalence in CF increased during the study period. Clinical and sociodemographic determinants of ADHD diagnosis were similar to the general population, whereas treatment and severity of CF appeared to have little influence. Our findings warrant future research evaluating diagnostic protocols and assessment of safety and efficacy of ADHD treatment in children with CF.
关于囊性纤维化（CF）患者注意力缺陷多动障碍（ADHD）的流行病学证据稀缺。
我们采用逐步逻辑回归来研究ADHD诊断与选定患者特征之间的关联。
这是一项对3至18岁CF医疗补助受益人的住院和门诊计费数据的横断面分析，以获取1999年至2006年ADHD诊断患病率和发病率估计值。
ADHD年患病率从5.26%（95%置信区间：5.25 - 5.27）增加了1.55倍，至8.16%（8.15 - 8.17），ADHD年发病率从1.70%（1.70 - 1.71）略有上升至2.01%（2.00 - 2.01）。与普通人群一样，男性被诊断为ADHD的可能性显著高于女性（优势比：1.97 [置信区间：1.49 - 2.60]），近期诊断患有焦虑、情绪障碍、抑郁、适应障碍以及学习、运动和沟通障碍的儿童也是如此。被诊断为ADHD的患者也更有可能处于寄养状态（优势比 = 4.36 [置信区间：2.26 - 8.40]）。除了近期使用脱氧核糖核酸酶（优势比 = 0.64 [置信区间：0.43 - 0.93]）外，CF严重程度指标以及包括胰酶、吸入用妥布霉素、吸入或口服皮质类固醇、吸入性支气管扩张剂和口服抗生素在内的药物与ADHD诊断均无关联。
在研究期间，CF患者中ADHD的患病率有所增加。ADHD诊断的临床和社会人口学决定因素与普通人群相似，而CF的治疗和严重程度似乎影响不大。我们的研究结果值得未来开展研究，以评估CF儿童的诊断方案以及ADHD治疗的安全性和有效性。
