Oehrlein Elisabeth M, Burcu Mehmet, Safer Daniel J, Zito Julie Magno
Ms. Oehrlein, Mr. Burcu, and Dr. Zito are with the Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore. Dr. Zito is also with the Department of Psychiatry at the university. Dr. Safer is with the Department of Psychiatry and the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore.
Psychiatr Serv. 2016 Sep 1;67(9):964-9. doi: 10.1176/appi.ps.201500269. Epub 2016 May 16.
The study objective was to assess national trends in the diagnosis of attention-deficit hyperactivity disorder (ADHD) in outpatient visits by comparing adults and youths. Also examined were recent stimulant prescribing patterns for ADHD visits by youths and adults.
Databases from the 1999-2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey were used in this cross-sectional study to analyze outpatient visit data of youths (ages two to 17 years; unweighted N=112,404) and adults (ages 18-64; unweighted N=426,209). The 12-year trends in ADHD visits were assessed as a proportion of youth and adult visits. The interaction of time period and age group was added to multivariable and weighted logistic regression models to assess whether trends in ADHD diagnosis differed by age group.
As a percentage of total visits, those involving an ADHD diagnosis were more common among youths than adults. However, from 1999 through 2010, the percentage of total visits involving a diagnosis of ADHD increased proportionally more among adult visits (from .3%, unweighted N=363 of 132,065, to .7%, unweighted N=1,015 of 154,764; adjusted odds ratio [AOR]=2.7, 95% confidence interval [CI]=2.1-3.7) than among youth visits (from 3.9%, unweighted N=2,033 of 36,263, to 5.2%, unweighted N=2,609 of 37,906; AOR=1.3, CI=1.1-1.6; p<.001). ADHD visits by adults compared with those by youths represented significantly greater proportions of females, Caucasians, patients with private insurance, and visits with a psychiatrist. Stimulant prescribing was common in ADHD visits regardless of age group (>70%).
As a percentage of total office-based visits, those at which ADHD was diagnosed increased more among adults than among youths from 1999 to 2010. Further research is warranted on the appropriateness, benefit-risk, and policy implications of stimulant use among adults with ADHD.
本研究的目的是通过比较成年人和青少年，评估门诊就诊中注意力缺陷多动障碍（ADHD）诊断的全国趋势。同时还研究了青少年和成年人ADHD就诊的近期兴奋剂处方模式。
在这项横断面研究中，使用了1999 - 2010年国家门诊医疗护理调查和国家医院门诊医疗护理调查的数据库，以分析青少年（2至17岁；未加权N = 112,404）和成年人（18 - 64岁；未加权N = 426,209）的门诊就诊数据。ADHD就诊的12年趋势以青少年和成年人就诊的比例进行评估。将时间段和年龄组的交互作用纳入多变量和加权逻辑回归模型，以评估ADHD诊断趋势是否因年龄组而异。
作为总就诊次数的百分比，涉及ADHD诊断的就诊在青少年中比在成年人中更常见。然而，从1999年到2010年，涉及ADHD诊断的总就诊次数百分比在成人就诊中增加的比例（从未加权的132,065次就诊中的363次，占0.3%，增加到154,764次就诊中的1,015次，占0.7%；调整后的优势比[AOR] = 2.7，95%置信区间[CI] = 2.1 - 3.7）比在青少年就诊中增加的比例（从未加权的36,263次就诊中的2,033次，占3.9%，增加到37,906次就诊中的2,609次，占5.2%；AOR = 1.3，CI = 1.1 - 1.6；p <.001）更大。与青少年的ADHD就诊相比，成年人的ADHD就诊在女性、白种人、有私人保险的患者以及精神科就诊中所占比例显著更高。无论年龄组如何，兴奋剂处方在ADHD就诊中都很常见（>70%）。
从1999年到2010年，作为基于办公室的总就诊次数的百分比，ADHD诊断的就诊在成年人中增加的幅度比在青少年中更大。有必要对ADHD成年人使用兴奋剂的适宜性、利弊及政策影响进行进一步研究。
