The risk of injury in adults with attention-deficit hyperactivity disorder: A nationwide, matched-cohort, population-based study in Taiwan

Wu-Chien Chien; Chi-Hsiang Chung; Fu-Huang Lin; Chin-Bin Yeh; San-Yuan Huang; Ru-Band Lu; Hsin-An Chang; Yu-Chen Kao; Wei-Shan Chiang; Yu-Ching Chou; Chang-Huei Tsao; Yung-Fu Wu; Nian-Sheng Tzeng

doi:10.1016/j.ridd.2017.04.011

The risk of injury in adults with attention-deficit hyperactivity disorder: A nationwide, matched-cohort, population-based study in Taiwan

Res Dev Disabil. 2017 Jun;65:57-73. doi: 10.1016/j.ridd.2017.04.011. Epub 2017 May 2.

Authors

Wu-Chien Chien¹, Chi-Hsiang Chung², Fu-Huang Lin³, Chin-Bin Yeh⁴, San-Yuan Huang⁴, Ru-Band Lu⁵, Hsin-An Chang⁶, Yu-Chen Kao⁷, Wei-Shan Chiang⁸, Yu-Ching Chou³, Chang-Huei Tsao⁹, Yung-Fu Wu¹⁰, Nian-Sheng Tzeng¹¹

Affiliations

¹ Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.
² Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC.
³ School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.
⁴ Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC.
⁵ Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; Division of Clinical Psychology, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan, ROC; Center for Neuropsychiatric Research, National Health Research Institute, Zhunan, Miaoli County, Taiwan, ROC.
⁶ Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC.
⁷ Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan, ROC.
⁸ Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Department and Institute of Mathematics, Tamkang University, New Taipei City, Taiwan, ROC.
⁹ Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan, ROC.
¹⁰ Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
¹¹ Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC. Electronic address: pierrens@mail.ndmctsgh.edu.tw.

PMID: 28458048
DOI: 10.1016/j.ridd.2017.04.011

Abstract

Background: Few studies have investigated the risk of injuries associated with adults with attention-deficit hyperactivity disorder (ADHD), even though several studies have suggested a higher risk of injury in children and adolescents with ADHD.

Aims: To investigate the risk of injury in adults with ADHD.

Methods and procedures: We included 665 adults with ADHD from January 1, to December 31, 2000, and 1995 sex-, age- and index day-matched controls without ADHD from the Longitudinal Health Insurance Database (LHID) subset of the National Health Insurance Research Database in Taiwan. The Cox proportional hazard models were used to analyze the associations between the relevant demographics, and the psychiatric comorbidities and the risk of injury.

Outcomes and results: The patients with ADHD had a 143% increased risk of overall injuries than the controls after considering all the confounding factors. In addition, the use of methylphenidate was associated with a 22.6% decrease in the risk of injuries in the patients with ADHD.

Conclusions and implications: Our findings strongly support that adults with ADHD are at an increased risk of injury, and imply that methylphenidate therapy may attenuate this risk.

Keywords: Adults; Attention-deficit hyperactivity disorder; Injury; National Health Insurance Database.

MeSH terms

Adult
Attention Deficit Disorder with Hyperactivity* / complications
Attention Deficit Disorder with Hyperactivity* / drug therapy
Attention Deficit Disorder with Hyperactivity* / epidemiology
Central Nervous System Stimulants / therapeutic use
Female
Humans
Insurance Claim Review / statistics & numerical data
Male
Matched-Pair Analysis
Methylphenidate / therapeutic use*
Proportional Hazards Models
Risk Assessment
Risk Factors
Taiwan / epidemiology
Wounds and Injuries* / diagnosis
Wounds and Injuries* / epidemiology
Wounds and Injuries* / etiology
Wounds and Injuries* / prevention & control

Substances

Central Nervous System Stimulants
Methylphenidate