The Risk of Hospitalizations with Injury Diagnoses in a Matched Cohort of Children and Adolescents with and without Attention Deficit/Hyperactivity Disorder in Germany: A Database Study

Abstract

BackgroundAttention deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder in children and adolescents worldwide, and children with ADHD have elevated risk of injuries. Our aim was to assess the risk of hospitalizations with injury diagnoses and their various subtypes in children and adolescents with newly diagnosed ADHD compared to those without ADHD, as well as to study sex effects on this risk in the setting of the German health care system.MethodsThe German Pharmacoepidemiological Research Database, in which 20 million insured from four statutory health insurances in Germany are included, was used to set up a matched cohort study of 3- to 17-year-old children and adolescents with and without ADHD. We calculated age-specific incidence rates and used Cox regression to obtain hazard ratios (HRs) for hospitalizations with injury diagnoses. We used the injury mortality diagnosis matrix for classification of injuries.ResultsThe matched cohort comprised a total of 75,300 children. The age-specific incidence rates for hospitalization with injury diagnosis for males with ADHD displayed a u-shaped form with highest incidences in the in the age groups 3–6 years [26.2 per 1,000 person-years; 95% confidence interval (CI) 20.5–33.0] and 18–21 years (28.6; 22.4–36.0). Girls with ADHD were less affected in younger age-groups, but the incidence rate for 18–21 year olds was similar to boys with ADHD (26.4; 17.4–38.4). The adjusted HR for children with ADHD was 1.40 (95% CI 1.30–1.49) compared to non-affected children. With respect to nature of injury, ADHD was associated with hospitalization with injury diagnoses of the internal organs, open wounds, and contusions but not with other injuries. With respect to body regions, children with ADHD were more prone to hospitalizations with injuries of the abdomen, traumatic brain injuries, other head injuries, and system-wide injuries such as poisoning and intoxication. No significant associations were seen for the other body regions. Differences between sexes were only seen for system-wide injuries.ConclusionChildren and adolescents with ADHD are at an increased risk for hospitalizations with diagnoses of injuries compared to non-affected children. Despite differences in health-care systems, the risk increase is at a similar level in Germany as in other countries.

<p>Association Between Attention Deficit Hyperactivity Disorder and Risk of Burn Injury: A Propensity-Matched Cohort Study</p>

“…A database study conducted in Germany compared the risk of hospitalization due to injury between patients aged 3-17 years newly diagnosed as having ADHD and those without ADHD; the results revealed no significant increase in burn risk among patients with ADHD. 7 However, we noted that confounders were not studied in the preceding study, and the heterogeneity of characteristics may have interfered in the evaluation of the influence of ADHD. In another national cohort study, a nationally representative study population of more than 10,000 children aged 5-15 years was selected from a registry database to assess the relationship between unintentional injury and childhood psychiatric disorder.…”

“…These symptoms are indicative of impairment of executive function. 2 Several studies have revealed that ADHD is associated with injury proneness, [3][4][5][6][7][8] and children with ADHD have more severe injuries and more often require hospital treatment following an injury than do those without ADHD. 9,10 The incidence of injury results in the shortening of life expectancy and is one of the most common causes of death among children with ADHD.…”

“…Studies investigating ADHD and injury proneness through database analyses have reported burn injury risk among patients with ADHD. [4][5][6][7]20 However, the results of these studies were inconclusive. A national cohort study conducted in the United Kingdom examined correlations between childhood psychiatric disorder and unintentional injury in more than 10,000 children aged 5-15 years.…”

“…Another database study conducted in Germany identified no significant difference in burn risk between children with ADHD and those without. 7 One population study conducted using claims data in Taiwan reported that patients with ADHD had a higher burn injury risk than did controls, with the corresponding odds ratio (OR) being 1.6. 5 Individuals aged 6-18 years were included in the study; those aged younger than 5 years, who are at higher risk of burn injury, 21,22 were not examined in the study.…”

Aggravation of symptom severity in adult attention-deficit/hyperactivity disorder by latent Toxoplasma gondii infection: a case–control study

“…Furthermore, latent toxoplasmosis has been associated with lengthened reaction times 38 , deficits in motor performance 39 , reduced anxiety 40 , and increased novelty-seeking behavior 41 . In concordance, impaired concentration capacity, motor skills and motor control as well as lengthened reaction time 42 , increased novelty-seeking behavior 41 , and an increased risk of injury 43 have also been described in patients with ADHD.…”