Methylphenidate Use and Infectious Diseases in Children With Attention Deficit and Hyperactivity Disorder: A Population-Based Study.

Kai-Liang Kao,Min-Jing Lee,Vincent Chin-Hung Chen,Shu-I Wu,Michael Gossop,Yi-Lung Chen

doi:10.3389/fmed.2021.787745

Abstract

ObjectiveChildren with attention deficit hyperactivity disorder (ADHD) have more visits to the emergency department (ED) due to injuries than those without ADHD. However, no study has investigated whether children with ADHD have more ED visits or hospitalizations due to infectious diseases (IDs) and whether methylphenidate (MPH) treatment may reduce the risk.MethodThe incidence of ID-related ED visits or hospitalizations was defined as the main outcome. The Cox regression and conditional Poisson regression models were calculated to estimate hazard ratios (HRs) in the population level and relative risks for the self-controlled case series design, respectively.ResultsChildren with ADHD had higher rates of emergency visits (HR = 1.25, 95% CI: 1.23~1.27) and hospitalizations (HR = 1.28, 95% CI: 1.26~1.31) due to IDs than those without ADHD. In the ADHD subgroup, those who received MPH treatment have a reduced risk of emergency visits (HR = 0.10, 95% CI: 0.09~0.10) and hospitalizations (HR = 0.73, 95% CI: 0.71~0.75), compared to those without treatment. The risk of ID-related emergency visits decreased to 0.21 (95% CI: 0.21~0.22); and hospitalizations decreased to 0.71 (95% CI: 0.69~0.73). Within self-controlled analysis, it is demonstrated that compared with non-MPH exposed period, children with ADHD had significantly decreased risks for infection-related emergency visits (RR = 0.73, 95% CI: 0.68~0.78) or hospitalizations (RR = 0.19, 95% CI: 0.17~0.21) during MPH-exposed periods.Conclusions and RelevanceThis is the first study that reported an increased risk of ID-related healthcare utilizations in children with ADHD compared to those without, and that such risks may be significantly reduced in ADHD children that received MPH treatment.

Highlights

Attention deficit and hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood [1]
Using a large population-based dataset, we investigated whether higher rates of infectious diseases (IDs)-related emergency visits or hospitalizations were found in children with ADHD compared to those without
There were no significant differences in gender, age groups, or comorbidities between the ADHD and non-ADHD groups and standardized mean difference

Summary

Introduction

Attention deficit and hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood [1]. Physical injuries, suicides, or homicides were shown to be related to the excessive mortality [5, 6]. Emerging evidence has supported the treatment effects of methylphenidate (MPH) for ADHD symptoms or related adverse behavioral outcomes [7,8,9], as well as healthcare utilizations, such as visits to the emergency departments (EDs). Studies showed that MPH may account for 13∼34% decrease in risks of fracture [10,11,12,13], 34∼51% of brain injuries [12, 14], 19% of substance-related events [15], or 19∼72% of reductions in suicide [16, 17]. An 11% decrease in visits to EDs due to trauma [18], 38∼42% of ED visits due to motor vehicle crashes [19], or 58% of transport accidents [20] were found to be associated with MPH treatment

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Conclusion