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

https://doi.org/10.1016/j.jaac.2019.06.010Get rights and content

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.

Section snippets

Study Sample

We used data from the Truven Health MarketScan Commercial Claims and Encounters databases of de-identified inpatient, outpatient, and filled prescription claims.21 As confirmed with the University of Chicago institutional review board, the analysis of MarketScan Databases is exempt because records are de-identified, and informed consent is not required.

We identified all individuals with an ADHD diagnosis (codes 314 in the International Classification of Diseases, Ninth Edition [ICD-9]) or an

Results

We identified 1,968,146 individuals with a diagnosis of ADHD or a prescription for ADHD medication during the follow-up time. The main characteristics of the study cohort are presented in Table 1. More than 60% of the sample were boys, and the median age at the start of the follow-up was 11 for boys and 12 for girls. The proportion of individuals with at least one event was higher in boys (4.8%) than in girls (3.6%).

Discussion

To our knowledge, this is the first study that has investigated the concurrent association between ADHD medication use and risk of ED visits for unintentional injuries in children and adolescents in the United States. The large sample size allowed us to obtain separate estimates across sexes, age groups, and different types of injuries. Furthermore, we were able to specifically focus on unintentional injuries (ie, excluding intentional self-harm). We found that use of ADHD medication was

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    Dr. Hur served as the statistical expert for this research.

    Disclosure: Dr. Larsson has served as a speaker for Evolan and Shire and has received research grants from Shire, all outside the submitted work. Dr. Gibbons has been an expert witness for the US Department of Justice, Merck, GlaxoSmithKline, Pfizer, and Wyeth and is a founder of Adaptive Testing Technologies, which distributes the CAT-MH™ battery of adaptive tests. The terms of this arrangement have been reviewed and approved by the University of Chicago in accordance with its conflict of interest policies. Drs. Chang, Chen, Quinn, Hur, D’Onofrio, and Ms. Ghirardi have reported no biomedical financial interests or potential conflicts of interest.

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