药物对注意力缺陷多动障碍儿童受伤风险的影响：一项前瞻性队列研究。

Effect of drugs on the risk of injuries in children with attention deficit hyperactivity disorder: a prospective cohort study.

作者信息

Dalsgaard Søren, Leckman James F, Mortensen Preben Bo, Nielsen Helena Skyt, Simonsen Marianne

机构信息

National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark; Department for Child and Adolescent Psychiatry, Hospital of Telemark, Kragerø, Norway.

Child Study Center, Yale University School of Medicine, New Haven, CT, USA.

出版信息

Lancet Psychiatry. 2015 Aug;2(8):702-709. doi: 10.1016/S2215-0366(15)00271-0. Epub 2015 Jul 22.

DOI:10.1016/S2215-0366(15)00271-0

PMID:26249301

Abstract

BACKGROUND

Injuries represent the largest disease burden and most common cause of death in children. Attention deficit hyperactivity disorder (ADHD) is associated with increased mortality, with accidents being the most common cause of death in ADHD. However, it is not known whether pharmacological treatment has any modifying effect on the risk of injuries in children and adolescents with ADHD.

METHODS

Using Danish national registers, we followed a cohort of 710 120 individuals, including 4557 individuals diagnosed with ADHD before age 10 years. Using a quasi-experimental, difference-in-difference design, we estimated the odds ratios (ORs) for injuries and the mean change in prevalence rates of injuries and emergency ward visits before and after treatment, with matched untreated children with ADHD at the same age serving as controls.

FINDINGS

Children with ADHD were more likely to sustain injuries, compared with children without ADHD, at age 10 years (adjusted OR=1·29, 95% CI 1·22-1·37) and at age 12 years (adjusted OR=1·30, 1·23-1·37). From age 5 to 10 years, the prevalence of injuries in children with ADHD who were treated with ADHD drugs decreased from 19% to 14%, compared with a prevalence of about 17% in non-treated children with ADHD. This corresponded to an adjusted difference-in-difference reduction in prevalence of injuries at age 10 years of 31·5% (8·2-54·8) and 43·5% (18·1-69·0) at age 12 years due to treatment. Pharmacological treatment also reduced the prevalence of emergency ward visits at age 10 years (28·2%, 6·3-50·1) and age 12 years (45·7%, 25·8-65·7).

INTERPRETATION

Children with ADHD had an increased risk of injuries compared with other children. Treatment with ADHD drugs reduced the risk of injuries by up to 43% and emergency ward visits by up to 45% in children with ADHD. Taken together with previous findings of accidents being the most common cause of death in individuals with ADHD, these results are of major public health importance.

FUNDING

The Lundbeck Foundation, the Danish Council for Independent Research, Centre For Integrated Register-based Research at Aarhus University, the Region of Southern Denmark Research Foundation, and Wørzner's Foundation.

摘要

背景

伤害是儿童中最大的疾病负担和最常见的死亡原因。注意力缺陷多动障碍（ADHD）与死亡率增加相关，意外事故是ADHD患者最常见的死亡原因。然而，尚不清楚药物治疗对患有ADHD的儿童和青少年的伤害风险是否有任何调节作用。

方法

利用丹麦国家登记册，我们追踪了710120人的队列，其中包括4557名在10岁前被诊断为ADHD的个体。采用准实验性的差异分析设计，我们估计了受伤的比值比（OR）以及治疗前后受伤患病率和急诊就诊率的平均变化，以年龄匹配的未接受治疗的ADHD儿童作为对照。

结果

与未患ADHD的儿童相比，患ADHD的儿童在10岁时（调整后的OR = 1.29，95%CI 1.22 - 1.37）和12岁时（调整后的OR = 1.30，1.23 - 1.37）受伤的可能性更高。从5岁到10岁，接受ADHD药物治疗的ADHD儿童的受伤患病率从19%降至14%，而未接受治疗的ADHD儿童的患病率约为17%。这相当于10岁时因治疗导致的受伤患病率调整后的差异减少了31.5%（8.2 - 54.8），12岁时减少了43.5%（18.1 - 69.0）。药物治疗还降低了10岁时（28.2%，6.3 - 50.1）和12岁时（45.7%，25.8 - 65.7）的急诊就诊率。