Mental Health Center, Shantou University Medical College, North Taishan Road, Shantou, 515065, Guangdong Province, China.
Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, Guangdong Province, China.
Environ Sci Pollut Res Int. 2021 Jan;28(2):1370-1380. doi: 10.1007/s11356-020-11269-y. Epub 2020 Oct 23.
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder which is caused by the interplay of genetic and environmental risk factors such as second-hand smoke (SHS). The association between postnatal exposure to SHS and ADHD risk in children was still inconclusive. We performed a systematic review and meta-analysis to explore the definite association. We searched for relevant studies from PubMed, Embase, Ovid, and Web of Science databases up to January 2020. We used random effect models to calculate pooled odds ratio (OR) with 95% confidence interval (CI). Subgroup analyses and sensitive analyses were also performed to solve the heterogeneity. According to our inclusion criteria, 9 studies including 6 cross-sectional studies, 2 cohort studies, and 1 case-control study were included in the final analysis. Postnatal exposure to SHS increased the risk of ADHD in children (OR: 1.60; 95% CI: 1.37-1.87). Children who exposed to SHS were found a slight risk for conduct problems (OR: 1.33, 95% CI: 1.00-1.77). Among the studies which used cotinine as a biomarker for SHS exposure, a lower pooled OR (OR = 1.16, 95%CI = 1.01, 1.33) was observed between cotinine and ADHD in children. Our meta-analysis results suggested that SHS exposure may be a risk factor for ADHD. We also found that SHS exposure may be associated with some adverse behavioral outcomes. More prospective studies should be conducted to confirm the relationship between SHS exposure and ADHD in children.
注意缺陷多动障碍（ADHD）是一种神经发育障碍，由遗传和环境风险因素相互作用引起，例如二手烟（SHS）。儿童出生后接触 SHS 与 ADHD 风险之间的关联仍不确定。我们进行了系统评价和荟萃分析，以探索明确的关联。我们从 PubMed、Embase、Ovid 和 Web of Science 数据库中搜索了截至 2020 年 1 月的相关研究。我们使用随机效应模型计算了合并的优势比（OR）及其 95%置信区间（CI）。还进行了亚组分析和敏感性分析，以解决异质性问题。根据我们的纳入标准，有 9 项研究（包括 6 项横断面研究、2 项队列研究和 1 项病例对照研究）最终纳入分析。儿童出生后接触 SHS 会增加患 ADHD 的风险（OR：1.60；95%CI：1.37-1.87）。接触 SHS 的儿童出现行为问题的风险略高（OR：1.33，95%CI：1.00-1.77）。在使用可替宁作为 SHS 暴露生物标志物的研究中，观察到可替宁与儿童 ADHD 之间的合并 OR 较低（OR=1.16，95%CI=1.01，1.33）。我们的荟萃分析结果表明，SHS 暴露可能是 ADHD 的一个危险因素。我们还发现，SHS 暴露可能与一些不良行为结果有关。应该进行更多的前瞻性研究，以确认 SHS 暴露与儿童 ADHD 之间的关系。
