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注意缺陷多动障碍药物与儿童和青少年的非故意伤害

Attention-Deficit/Hyperactivity Disorder Medication and Unintentional Injuries in Children and Adolescents.

机构信息

Karolinska Institutet, Stockholm, Sweden.

Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden.

出版信息

J Am Acad Child Adolesc Psychiatry. 2020 Aug;59(8):944-951. doi: 10.1016/j.jaac.2019.06.010. Epub 2019 Jul 11.

Abstract

OBJECTIVE

Our objective was to determine whether attention-deficit/hyperactivity disorder (ADHD) medication is associated with a decreased risk of unintentional injuries in children and adolescents in the United States across sexes, age groups and injury types.

METHOD

We used de-identified inpatient, outpatient, and filled prescription claims data from the Truven Health MarketScan Research Databases. Individuals were followed from January 1, 2005, date of first ADHD diagnosis, or medication prescription, or age 6 years, whichever occurred last, until December 31, 2014, first healthcare insurance disenrollment, or the first year at which their age was recorded as 19 years, whichever occurred first. A person was considered on ADHD medication during a given month if a prescription was filled in that month. The outcome was defined as emergency department visits for injuries, including traumatic brain injuries, with unintentional causes. Odds of having the outcome were compared between medicated and unmedicated months at the population-level and in within-individual analyses using logistic regression.

RESULTS

Among 1,968,146 individuals diagnosed with ADHD or receiving ADHD medication, 87,154 had at least one event. At the population level, medication use was associated with a lower risk of injuries, both in boys (odds ratio [OR] = 0.85; 95% CI = 0.84-0.86) and girls (OR = 0.87; 95% CI = 0.85-0.89). Similar results were obtained from within-individual analysis among male (OR = 0.72; 95% CI = 0.70-0.74) and female (OR = 0.72; 95% CI = 0.69-0.75) children, and among male (OR = 0.64; 95% CI = 0.60-0.67) and female (OR = 0.65; 95% CI = 0.60-0.71) adolescents. Similar results were found for traumatic brain injuries.

CONCLUSION

ADHD medication use was associated with a reduction of different types of unintentional injuries in children and adolescents of both sexes.

摘要

目的

本研究旨在确定在美国,无论性别、年龄组和损伤类型如何,注意力缺陷多动障碍(ADHD)药物是否与儿童和青少年意外伤害风险降低相关。

方法

我们使用 Truven Health MarketScan 研究数据库的去识别住院、门诊和处方用药数据。自 2005 年 1 月 1 日(首次 ADHD 诊断或药物处方或年龄达到 6 岁的日期中最晚的日期)起,个体开始随访,直至 2014 年 12 月 31 日(首次退出医疗保健保险或记录年龄为 19 岁的第一年)。如果在某个月开了处方,则认为该个体在该月使用了 ADHD 药物。该研究的结局定义为因意外伤害(包括非故意原因引起的创伤性脑损伤)到急诊就诊。使用逻辑回归在人群水平和个体内分析中比较用药和未用药月份的结局发生比。

结果

在 1968146 名被诊断患有 ADHD 或接受 ADHD 药物治疗的个体中,有 87154 人至少发生了 1 次事件。在人群水平上,药物治疗与损伤风险降低相关,无论是男孩(比值比[OR] = 0.85;95%CI = 0.84-0.86)还是女孩(OR = 0.87;95%CI = 0.85-0.89)。个体内分析也得到了相似的结果,包括男性(OR = 0.72;95%CI = 0.70-0.74)和女性(OR = 0.72;95%CI = 0.69-0.75)儿童以及男性(OR = 0.64;95%CI = 0.60-0.67)和女性(OR = 0.65;95%CI = 0.60-0.71)青少年。对于创伤性脑损伤,也得到了相似的结果。

结论

ADHD 药物治疗与儿童和青少年不同类型的意外伤害风险降低相关。

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