Abstract
There is a controversy regarding temporal trends in prevalence of attention-deficit/hyperactivity disorder (ADHD). Using nationwide claims data containing data for approximately six million statutory health insured children we aimed to examine a) trends of ADHD administrative prevalence during 2009–2016; b) regional variations in prevalence, and c) factors associated with an increased chance of ADHD diagnosis. The ICD-10 code ‘F90-hyperkinetic disorder’ was used to define an ADHD case. Global and Local Moran’s I tests were used to examine the spatial autocorrelation and k-means-cluster analysis to examine the course of ADHD prevalence in administrative districts over years. Two-level logistic regression was applied to examine individual- and district-level factors associated with ADHD diagnosis. The administrative prevalence of ADHD was 4.33% (95% CI: 4.31–4.34%). We observed pronounced small-area differences on the district level with prevalences ranging between 1.6% and 9.7%. There was evidence of strong spatial autocorrelation (Global Moran’s I: 0.46, p < 0.0001). The k-means-method identified six clusters of different size; all with a stagnating trend in the prevalence over the observation period of eight years. On the district level, a lower proportion of foreign citizens, and a higher density of paediatric psychiatrists and paediatricians were positively associated with ADHD with a more pronounced effect in urban districts.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder primarily affecting children and adolescents
Using nationwide claims data containing data for approximately six million children we examined a) temporal trends of ADHD administrative prevalence estimates during 2009 to 2016; b) regional variations in ADHD prevalence, including small-area variations, and c) sociodemographic factors on the individual and district level associated with an increased chance of ADHD diagnosis
Applying Local Moran’s I statistics we identified two groups of clusters with low-low and high-high prevalences (Fig. 1c)
Summary
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder primarily affecting children and adolescents (from here on referred to as children). ADHD appears to be a public health issue in western countries with the highest prevalence estimates reported in the US and lowest in African and Asian countries[1]. Regional variations within countries were reported, e.g. in Germany[3], the UK4 and the US5. The question arising in this context is whether the prevalence increase over the last years is true or whether it is just the result of the heightened attention from the public, media and scientific community. Using nationwide claims data containing data for approximately six million children we examined a) temporal trends of ADHD administrative prevalence estimates during 2009 to 2016; b) regional variations in ADHD prevalence, including small-area variations, and c) sociodemographic factors on the individual and district level associated with an increased chance of ADHD diagnosis. Male Female Age groups 5–6 years 7–8 years 9–10 years 11–12 years 13–14 years German federal states Baden-Württemberg Bavaria Berlin Brandenburg Bremen Hamburg Hesse Mecklenburg-Western Pomerania Lower Saxony North Rhine-Westphalia Rhineland-Palatinate Saarland Saxony Saxony-Anhalt Schleswig-Holstein Thuringia
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