Shmueli Dorit, Razi Talish, Almog Moran, Menashe Idan, Mimouni Bloch Aviva
Child Development, Clalit Health Services, Tel Aviv, Israel.
Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel.
JAMA Netw Open. 2025 Feb 3;8(2):e2459029. doi: 10.1001/jamanetworkopen.2024.59029.
Injuries are a major cause of morbidity and mortality among children with neurodevelopmental conditions. Identifying injuries associated with this vulnerable population could inform specific preventive actions.
To compare the injury risk among children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), or coexisting ASD and ADHD with children with typical development (TD).
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study involved 325 412 children born between 2005 and 2009, followed up until the end of 2021. Data analysis was conducted from February 2 to November 14, 2023. The study data were extracted from the Clalit Health Service (CHS) database, which contains comprehensive clinical and sociodemographic data on all members of the CHS admitted to the emergency departments (EDs) of all hospitals in Israel during the study period. Children who were members of CHS born between 2005 and 2009 were classified into 4 groups: ASD, ADHD, ASD and ADHD, and TD (control).
Negative binomial regression models were used to assess incidence rate ratios (IRRs) of ED visits between the study groups and the control group. These models were adjusted for birth year, sector, and socioeconomic status. IRRs for specific injuries were also assessed. The statistical significance of IRRs was assessed using 95% CIs.
A total of 325 412 children (163 183 boys [50%]) were included in the study. Children with ASD, ADHD, or both had significantly higher ED visit rates than children with TD (IRR, 1.48 [95% CI, 1.42-1.55], 1.45 [95% CI, 1.39-1.52], and 1.29 [95% CI, 1.28-1.30], respectively). Children with ADHD had also higher rates of ED visits due to physical injuries compared with controls (IRR, 1.18 [95% CI, 1.16-1.20]), whereas children with ASD with or without ADHD did not (IRR, 0.96 [95% CI, 0.89-1.05] and 0.91 [95% CI, 0.83-1.00], respectively). A focused analysis of the injury profiles revealed that children with ASD or comorbid ASD and ADHD had higher rates of ingestion and inhalation injuries (IRR, 1.57 [95% CI, 1.06-2.25] and 1.80 [95% CI, 1.28-2.48], respectively) and lower rates of orthopedic injuries (IRR, 0.78 [95% CI, 0.69-0.89] and 0.83 [95% CI, 0.74-0.93], respectively), and animal-inflicted injuries (IRR, 0.44 [95% CI, 0.22-0.79] and 0.92 [95% CI, 0.60-1.35], respectively) than controls.
In this large cohort study, different types of injury were associated with children with ASD and ADHD. The causes underlying these associations should be further investigated to develop effective approaches for injury reduction among these children.
伤害是神经发育障碍儿童发病和死亡的主要原因。识别与这一弱势群体相关的伤害情况可为具体的预防行动提供依据。
比较自闭症谱系障碍（ASD）、注意力缺陷多动障碍（ADHD）或同时患有ASD和ADHD的儿童与发育正常（TD）儿童的受伤风险。
设计、背景和参与者：这项基于人群的队列研究纳入了2005年至2009年出生的325412名儿童，随访至2021年底。数据分析于2023年2月2日至11月14日进行。研究数据从克拉利特健康服务（CHS）数据库中提取，该数据库包含了研究期间以色列所有医院急诊科收治的CHS所有成员的综合临床和社会人口学数据。2005年至2009年出生的CHS成员儿童被分为4组：ASD组、ADHD组、ASD和ADHD组以及TD（对照组）。
采用负二项回归模型评估研究组与对照组之间急诊就诊的发病率比（IRR）。这些模型对出生年份、部门和社会经济地位进行了调整。还评估了特定伤害的IRR。使用95%置信区间评估IRR的统计学显著性。
共有325412名儿童（163183名男孩[50%]）纳入研究。患有ASD、ADHD或两者皆有的儿童急诊就诊率显著高于TD儿童（IRR分别为1.48[95%CI，1.42 - 1.55]、1.45[95%CI，1.39 - 1.52]和1.29[95%CI，1.28 - 1.30]）。与对照组相比，ADHD儿童因身体伤害导致的急诊就诊率也更高（IRR为1.18[95%CI，1.16 - 1.20]），而患有或未患有ADHD的ASD儿童则不然（IRR分别为0.96[95%CI，0.89 - 1.05]和0.91[95%CI，0.83 - 1.00]）。对伤害情况的重点分析显示，患有ASD或ASD合并ADHD的儿童摄入和吸入性伤害发生率更高（IRR分别为1.57[95%CI，1.06 - 2.25]和1.80[95%CI，1.28 - 2.48]），骨科伤害发生率更低（IRR分别为0.78[95%CI，0.69 - 0.89]和0.83[95%CI，0.74 - 0.93]），动物致伤发生率也更低（IRR分别为0.44[95%CI，0.22 - 0.79]和0.92[95%CI，0.60 - 1.35]）。
在这项大型队列研究中，不同类型的伤害与ASD和ADHD儿童相关。应进一步调查这些关联背后的原因，以制定有效的方法来减少这些儿童的伤害。
