Furu Kari, Karlstad Øystein, Zoega Helga, Martikainen Jaana E, Bahmanyar Shahram, Kieler Helle, Pottegård Anton
Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway.
Centre of Public Health Sciences, Faculty of Medicine, University of Iceland Reykjavik, Reykjavik, Iceland.
Basic Clin Pharmacol Toxicol. 2017 Apr;120(4):373-379. doi: 10.1111/bcpt.12724. Epub 2017 Jan 30.
Use of stimulants to treat attention-deficit/hyperactivity disorder (ADHD) has increased over the past two decades and varies substantially between countries. The objective of this multinational population-based study was to examine utilization of ADHD drugs (stimulants and atomoxetine) including comedication with other psychotropic drugs in the entire child population in the five Nordic countries. We included longitudinal data on dispensed ADHD drugs from five Nordic prescription registers during 2008-2012, which in 2012 comprised 48,296 individuals among 5.42 million inhabitants aged 0-17 years. Prevalence of filling ≥1 prescriptions of ADHD drugs among children aged 6-17 years increased during 2008-2012 from 5.9 to 11.2 and 19.4 to 31.0 per 1000 girls and boys, respectively. Prevalence by country showed that Iceland, Finland and Sweden had a steady increase during the study period, while in Norway the prevalence was quite stable and in Denmark it levelled off from 2010. Use in preschoolers (aged 0-5 years) was rare. Iceland had much higher prevalence and incidence than the other Nordic countries. The incidence of ADHD drug use increased during the study period, from 4.0 to 4.9 and from 1.5 to 2.3 per 1000 boys and girls, respectively. The increasing number of new users levelled off somewhat after 2010. Comedication with other psychotropic drugs was more common among girls (33.9%) than boys (27.0%) and was mainly melatonin, followed by antidepressants and antipsychotics. Overall prevalence of ADHD drug use increased among Nordic girls and boys aged 6-17 years, whereas the incidence increased slightly during 2008-2010 but levelled off through 2012. The substantial differences in ADHD drug use across the Nordic countries and high degree of comedication with other psychotropic drugs underscore the importance of close monitoring of treatment for ADHD among children.
在过去二十年中，使用兴奋剂治疗注意力缺陷多动障碍（ADHD）的情况有所增加，且各国之间差异很大。这项基于多国人群的研究旨在调查北欧五国全体儿童中ADHD药物（兴奋剂和托莫西汀）的使用情况，包括与其他精神药物的联合用药情况。我们纳入了2008年至2012年期间来自五个北欧处方登记处的ADHD药物配药纵向数据，2012年这些数据涵盖了542万0至17岁居民中的48296人。2008年至2012年期间，6至17岁儿童中开具≥1张ADHD药物处方的患病率分别从每1000名女孩5.9例和每1000名男孩19.4例增至11.2例和31.0例。按国家划分的患病率显示，冰岛、芬兰和瑞典在研究期间呈稳步上升趋势，而挪威的患病率相当稳定，丹麦的患病率自2010年起趋于平稳。学龄前儿童（0至5岁）的使用情况很少见。冰岛的患病率和发病率远高于其他北欧国家。在研究期间，ADHD药物使用的发病率有所增加，分别从每1000名男孩4.0例和每1000名女孩1.5例增至4.9例和2.3例。2010年后，新使用者数量的增长有所趋缓。与其他精神药物联合用药在女孩中（33.9%）比在男孩中（27.0%）更为常见，主要是褪黑素，其次是抗抑郁药和抗精神病药。6至17岁北欧女孩和男孩中ADHD药物使用的总体患病率有所上升，而发病率在2008年至2010年期间略有上升，但到2012年趋于平稳。北欧国家之间ADHD药物使用的巨大差异以及与其他精神药物的高联合用药率凸显了密切监测儿童ADHD治疗的重要性。
