Patel Rikinkumar S, Patel Priya, Shah Kaushal, Kaur Mandeep, Mansuri Zeeshan, Makani Ramkrishna
Department of Psychiatry, Northwell Zucker Hillside Hospital.
Psychiatry, Windsor University School of Medicine.
Cureus. 2018 Jan 7;10(1):e2033. doi: 10.7759/cureus.2033.
Objective To determine the impact of cannabis use disorder (CUD) on the inpatient outcomes of attention deficit hyperactivity disorder (ADHD) in adolescents Background Previous studies have evaluated the impact of CUD on the health-related quality of life in ADHD patients. Methods We used the nationwide inpatient sample (NIS) from the Healthcare Cost and Utilization Project (HCUP) from years 2010--2014. We identified ADHD and cannabis use (CU) as the primary and the other diagnosis, respectively, using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD-9--CM) codes. We used the binomial logistic regression model to generate adjusted odds ratios (aOR). Results We analyzed a total of 11,232 ADHD adolescent hospital admissions from years 2010-2014; of these, 1.79% had CUD. The mean age of adolescents was 14.1 years (SD = 1.79). The prevalence of CUD was highest in ADHD adolescents of 15-18 years (73%) and common in the white race (71%). A higher proportion of ADHD with CUD was transferred to acute care hospitals and skilled/other nursing facilities (5.4% and 7.4% vs. 1.1% and 2.6%, respectively, p-value < 0.001). CUD increases the risk of inpatient charges > $12,247 (median) by 0.6 times (aOR = 1.835; p-value = 0.002) and increases the risk of inpatient stay > 5 days (median) by 0.7 times (aOR = 2.099; p-value < 0.001). The utilization of psychotropic medications was reduced by 0.8 times in ADHD with CUD adolescents by 0.8 times (aOR = 0.448; p-value = 0.017), and the implication of behavioral therapy in the management of ADHD with CUD adolescents was reduced by 0.9 times (aOR = 0.412; p-value = 0.048). Also, there is a 2.8 times higher risk of comorbid alcohol abuse in ADHD with CUD adolescents (aOR = 17.141; p-value < 0.001). Conclusion The increased risk of substance use is a long-term implication of ADHD in adolescents. It has been determined that comorbid CUD in patients with ADHD not only increases the risk of acute inpatient care but also prolongs the inpatient stay, thus increasing the healthcare cost. Surprisingly, comorbid CUD decreases the utilization of psychotropic medications and behavioral therapy in ADHD. Another major issue is the higher risk of comorbid alcohol abuse in ADHD with CUD adolescents. Further exploration with randomized controlled studies would be required to support and highlight the growing issue of cannabis use among adolescents with ADHD.
确定大麻使用障碍（CUD）对青少年注意力缺陷多动障碍（ADHD）住院结局的影响。背景：既往研究评估了CUD对ADHD患者健康相关生活质量的影响。方法：我们使用了2010 - 2014年医疗成本与利用项目（HCUP）的全国住院样本（NIS）。我们分别使用经过验证的国际疾病分类第九版及临床修订版（ICD - 9 - CM）编码，将ADHD和大麻使用（CU）确定为主要诊断和其他诊断。我们使用二项逻辑回归模型生成调整后的优势比（aOR）。结果：我们分析了2010 - 2014年期间共11232例ADHD青少年住院病例；其中，1.79%患有CUD。青少年的平均年龄为14.1岁（标准差 = 1.79）。CUD在15 - 18岁的ADHD青少年中患病率最高（73%），在白人种族中也较为常见（71%）。合并CUD的ADHD患者转至急症医院和专业/其他护理机构的比例更高（分别为5.4%和7.4%，而未合并CUD的分别为1.1%和2.6%，p值 < 0.001）。CUD使住院费用超过12247美元（中位数）的风险增加0.6倍（aOR = 1.835；p值 = 0.002），使住院时间超过5天（中位数）的风险增加0.7倍（aOR = 2.099；p值 < 0.001）。合并CUD的ADHD青少年使用精神药物的比例降低了0.8倍（aOR = 0.448；p值 = 0.017），合并CUD的ADHD青少年接受行为治疗的比例降低了0.9倍（aOR = 0.412；p值 = 0.048）。此外，合并CUD的ADHD青少年共病酒精滥用的风险高出2.8倍（aOR = 17.141；p值 < 0.001）。结论：物质使用风险增加是青少年ADHD的一个长期影响。已确定ADHD患者合并CUD不仅增加了急性住院治疗的风险，还延长了住院时间，从而增加了医疗成本。令人惊讶的是，合并CUD会降低ADHD患者精神药物和行为治疗的使用率。另一个主要问题是合并CUD的ADHD青少年共病酒精滥用的风险更高。需要进一步进行随机对照研究以支持并突出ADHD青少年中日益严重的大麻使用问题。
