Department of Psychiatry, Changhua Christian Children's Hospital, Changhua, Taiwan.
Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan.
Epidemiol Psychiatr Sci. 2021 Feb 15;30:e14. doi: 10.1017/S2045796021000032.
Although the relationship between attention-deficit/hyperactivity disorder (ADHD) and transport accidents has been shown, there is limited information on the relationship between medication and dose-response effects and transport accident risk. This study aims to determine whether young people with ADHD, including adolescents, are more prone to transport accidents than those without, and the extent to which methylphenidate (MPH) prescription in these patients reduces the risk.
We identified 114 486 patients diagnosed with ADHD from Taiwan's National Health Insurance Research Database from 1997 to 2013. Using a Cox regression model, we compared the risk of transport accidents between ADHD and non-ADHD groups and estimated the effect of MPH on accidents. Furthermore, we applied a self-control case-series analysis to compare the risk of accidents during the medication periods with the same patients' non-medication periods.
Male ADHD patients had a higher risk of transport accidents than non-ADHD individuals (adjusted hazard ratio [aHR] = 1.24, [95% confidence interval (CI) 1.10-1.39]), especially for those comorbid with epilepsy, oppositional defiant disorder/conduct disorder (ODD/CD), and intellectual disabilities (ID). Female ADHD patients showed no relationship, except for comorbid with autism spectrum disorder (ASD) or ID. We found a reduced risk of transport accidents in patients with ADHD with MPH medication than those without MPH, with a plausible dose-response relationship (aHR of 0.23 to 0.07). A similar pattern was found in self-controlled case-series analysis.
Male patients with ADHD, especially those comorbid with epilepsy, ODD/CD, or ID, were at high risk of transport accidents. Female patients, when comorbid with ASD or ID, also exhibited a higher risk of accidents. MPH treatment lowered the accident risk with a dose-response relationship.
虽然已经证明注意力缺陷多动障碍（ADHD）与交通事故之间存在关联，但关于药物治疗与剂量反应效应以及交通事故风险之间的关系，信息有限。本研究旨在确定患有 ADHD 的年轻人（包括青少年）是否比没有 ADHD 的人更容易发生交通事故，以及这些患者服用哌醋甲酯（MPH）是否能降低风险。
我们从台湾全民健康保险研究数据库中确定了 114486 名 1997 年至 2013 年被诊断为 ADHD 的患者。我们使用 Cox 回归模型比较了 ADHD 组和非 ADHD 组发生交通事故的风险，并估计了 MPH 对事故的影响。此外，我们应用了自对照病例系列分析，比较了相同患者用药期间和非用药期间发生事故的风险。
男性 ADHD 患者发生交通事故的风险高于非 ADHD 个体（调整后的危险比[aHR]=1.24[95%置信区间（CI）1.10-1.39]），特别是伴有癫痫、对立违抗性障碍/品行障碍（ODD/CD）和智力障碍（ID）的患者。女性 ADHD 患者则没有这种关系，除了伴有自闭症谱系障碍（ASD）或 ID 的患者。我们发现 ADHD 患者服用 MPH 比不服用 MPH 的患者发生交通事故的风险降低，存在合理的剂量反应关系（aHR 为 0.23 至 0.07）。在自对照病例系列分析中也发现了类似的模式。
患有 ADHD 的男性患者，特别是伴有癫痫、ODD/CD 或 ID 的患者，发生交通事故的风险较高。女性患者伴有 ASD 或 ID 时，也表现出更高的事故风险。MPH 治疗可降低风险，且与剂量呈正相关。
