Guo Nai-Wen, Lin Cheng-Li, Lin Cheng-Wei, Huang Ming-Tung, Chang Wei-Lun, Lu Tsung-Hsueh, Lin Chii-Jeng
aInstitute of Behavior Medicine, College of MedicinebDepartment of Orthopedics, National Cheng Kung University Hospital, College of MedicinecNCKU Research Center for Health Data and Department of Public Health, National Cheng Kung University, Tainan City, Taiwan.
J Pediatr Orthop B. 2016 Jul;25(4):369-74. doi: 10.1097/BPB.0000000000000243.
The aim of this study was to investigate the risk of fracture and the difference between sexes from a nationwide database of fracture risk among children aged 4-17 years with or without attention deficit hyperactivity disorder (ADHD, ICD-9-CD codes 314). The Longitudinal Health Insurance Database (LHID 2000) was used to analyze fracture characteristics of children from the National Health Insurance that covered 96.1% of the Taiwanese population (N=21.4 million). A total of 7200 ADHD children aged between 4 and 17 years whose diagnosis had been confirmed in at least three outpatient clinics between 1 January 2000 and 31 December 2009 were included, and a cohort of 36 000 children without ADHD matched for age, sex, and urbanization was recruited for analysis. The incidence rate of fractures in ADHD children was 21.0 (95% confidence interval=19.4-22.7) per 1000 person-years, significantly (P<0.001) higher than 15.0 (95% confidence interval=14.4-15.6) in non-ADHDs. After adjusting by age, sex, urbanization level, and geographic region, the statistically significant (P<0.001) hazard ratios (HR) of fracture for ADHD children compared with non-ADHD children included 1.62 in girls and 1.38 in boys, 1.53 in the skull, neck, and trunk (ICD-9-CM 800-809), 1.28 in the upper extremity (ICD-9-CM 810-819), and 1.84 in the lower extremity (ICD-9-CM 820-829). The HR also (P<0.001) increased significantly in all age groups, including 1.35 in 4-6, 1.37 in 7-9, and 1.54 in 10-17 years. ADHD should be listed among risk factors of children's fractures in each sex, all age groups, and all body areas that the parents, teachers, caregivers of ADHD children, and pediatric orthopedists should be aware of. Besides, ADHD girls were more affected than ADHD boys, especially after 10 years of age, whereas the adjusted HR was the highest in the lower extremities. Nationwide analysis matched for age and sex showed that ADHD should be considered the risk factor of children's fracture, especially for girls older than 10 years of age.
本研究旨在通过一个全国性数据库，调查4至17岁患有或未患有注意力缺陷多动障碍（ADHD，国际疾病分类第九版临床修订本编码314）儿童的骨折风险及性别差异。纵向健康保险数据库（LHID 2000）用于分析来自覆盖96.1%台湾人口（N = 2140万）的国民健康保险中的儿童骨折特征。纳入了2000年1月1日至2009年12月31日期间在至少三家门诊确诊的7200名4至17岁ADHD儿童，并招募了36000名年龄、性别和城市化程度相匹配的非ADHD儿童作为队列进行分析。ADHD儿童的骨折发病率为每1000人年21.0（95%置信区间 = 19.4 - 22.7），显著高于非ADHD儿童的15.0（95%置信区间 = 14.4 - 15.6）（P < 0.001）。在按年龄、性别、城市化水平和地理区域进行调整后，与非ADHD儿童相比，ADHD儿童骨折的统计学显著（P <
