Chang Zheng, Quinn Patrick D, Hur Kwan, Gibbons Robert D, Sjölander Arvid, Larsson Henrik, D'Onofrio Brian M
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden2Center for Health Statistics, The University of Chicago, Chicago, Illinois.
Center for Health Statistics, The University of Chicago, Chicago, Illinois3Department of Psychological and Brain Sciences, Indiana University, Bloomington.
JAMA Psychiatry. 2017 Jun 1;74(6):597-603. doi: 10.1001/jamapsychiatry.2017.0659.
Motor vehicle crashes (MVCs) are a major public health problem. Research has demonstrated that individuals with attention-deficit/hyperactivity disorder (ADHD) are more likely to experience MVCs, but the effect of ADHD medication treatment on the risk of MVCs remains unclear.
To explore associations between ADHD medication use and risk of MVCs in a large cohort of patients with ADHD.
DESIGN, SETTING, AND PARTICIPANTS: For this study, a US national cohort of patients with ADHD (n = 2 319 450) was identified from commercial health insurance claims between January 1, 2005, and December 31, 2014, and followed up for emergency department visits for MVCs. The study used within-individual analyses to compare the risk of MVCs during months in which patients received ADHD medication with the risk of MVCs during months in which they did not receive ADHD medication.
Dispensed prescription of ADHD medications.
Emergency department visits for MVCs.
Among 2 319 450 patients identified with ADHD, the mean (SD) age was 32.5 (12.8) years, and 51.7% were female. In the within-individual analyses, male patients with ADHD had a 38% (odds ratio, 0.62; 95% CI, 0.56-0.67) lower risk of MVCs in months when receiving ADHD medication compared with months when not receiving medication, and female patients had a 42% (odds ratio, 0.58; 95% CI, 0.53-0.62) lower risk of MVCs in months when receiving ADHD medication. Similar reductions were found across all age groups, across multiple sensitivity analyses, and when considering the long-term association between ADHD medication use and MVCs. Estimates of the population-attributable fraction suggested that up to 22.1% of the MVCs in patients with ADHD could have been avoided if they had received medication during the entire follow-up.
Among patients with ADHD, rates of MVCs were lower during periods when they received ADHD medication. Considering the high prevalence of ADHD and its association with MVCs, these findings warrant attention to this prevalent and preventable cause of mortality and morbidity.
机动车碰撞事故（MVCs）是一个重大的公共卫生问题。研究表明，患有注意力缺陷多动障碍（ADHD）的个体更有可能发生机动车碰撞事故，但ADHD药物治疗对机动车碰撞事故风险的影响仍不明确。
探讨大量ADHD患者中ADHD药物使用与机动车碰撞事故风险之间的关联。
设计、背景和参与者：在本研究中，从2005年1月1日至2014年12月31日的商业健康保险理赔记录中识别出一个美国全国性的ADHD患者队列（n = 2319450），并对因机动车碰撞事故前往急诊科就诊的情况进行随访。该研究采用个体内分析，比较患者接受ADHD药物治疗的月份与未接受ADHD药物治疗的月份发生机动车碰撞事故的风险。
ADHD药物的处方配药。
因机动车碰撞事故前往急诊科就诊。
在识别出的2319450例ADHD患者中，平均（标准差）年龄为32.5（12.8）岁，51.7%为女性。在个体内分析中，患有ADHD的男性患者在接受ADHD药物治疗的月份发生机动车碰撞事故的风险比未接受药物治疗的月份低38%（比值比，0.62；95%置信区间，0.56 - 0.67），女性患者在接受ADHD药物治疗的月份发生机动车碰撞事故的风险低42%（比值比，0.58；95%置信区间，0.53 - 0.62）。在所有年龄组、多项敏感性分析以及考虑ADHD药物使用与机动车碰撞事故的长期关联时，均发现了类似的降低情况。人群归因分数估计表明，如果ADHD患者在整个随访期间都接受药物治疗，高达22.1%的机动车碰撞事故本可避免。
在ADHD患者中，接受ADHD药物治疗期间机动车碰撞事故发生率较低。鉴于ADHD的高患病率及其与机动车碰撞事故的关联，这些发现值得关注这一普遍且可预防的死亡和发病原因。
