ABSTRACT
AIMS: Attention-deficit/hyperactivity disorder (ADHD) is associated with a higher risk of burn injury than in the normal population. Nevertheless, the influence of methylphenidate (MPH) on the risk of burn injury remains unclear. This retrospective cohort study analysed the effect of MPH on the risk of burn injury in children with ADHD. METHOD: Data were from Taiwan's National Health Insurance Research Database (NHIRD). The sample comprised individuals younger than 18 years with a diagnosis of ADHD (n = 90 634) in Taiwan's NHIRD between January 1996 and December 2013. We examined the cumulative effect of MPH on burn injury risk using Cox proportional hazards models. We conducted a sensitivity analysis for immortal time bias using a time-dependent Cox model and within-patient comparisons using the self-controlled case series model. RESULTS: Children with ADHD taking MPH had a reduced risk of burn injury, with a cumulative duration of treatment dose-related effect, compared with those not taking MPH. Compared with children with ADHD not taking MPH, the adjusted hazard ratio for burn injury was 0.70 in children taking MPH for <90 days (95% confidence interval (CI) 0.64-0.77) and 0.43 in children taking MPH for ≥90 days (95% CI 0.40-0.47), with a 50.8% preventable fraction. The negative association of MPH was replicated in age-stratified analysis using time-dependent Cox regression and self-controlled case series models. CONCLUSION: This study showed that MPH treatment was associated with a lower risk of burn injury in a cumulative duration of treatment dose-related effect manner.
Subject(s)
Attention Deficit Disorder with Hyperactivity/drug therapy , Burns/epidemiology , Central Nervous System Stimulants/therapeutic use , Methylphenidate/therapeutic use , Adolescent , Attention Deficit Disorder with Hyperactivity/epidemiology , Burns/etiology , Burns/psychology , Child , Child, Preschool , Female , Humans , Incidence , Male , Methylphenidate/adverse effects , Outcome Assessment, Health Care , Proportional Hazards Models , Retrospective Studies , Risk , Taiwan/epidemiologyABSTRACT
PURPOSE: Literature suggests that attention deficit hyperactivity disorder (ADHD) is associated with a high risk of unintentional injury. However, few studies have focused on whether risk of burn injury is relatively high among patients with ADHD. The aim of this study was to investigate whether ADHD affects the risk of burn injury. MATERIALS AND METHODS: Individuals aged <18 years with a current diagnosis of ADHD (N = 52,705) and age-, sex-, and other comorbidity-matched controls were selected from Taiwan's National Health Insurance Research Database for the period of January 1996 to December 2013. Burn injury was identified in both groups, and risk was evaluated using Cox proportional hazards models. We also explored the effects of age and sex on the association. RESULTS: We determined that patients with ADHD had an increased probability of burn injury compared with the control group (ADHD vs controls, 4.6% vs 2.6%; adjusted hazard ratio [aHR] = 1.78; 95% confidence interval [CI] = 1.66-1.90). The effect of ADHD on burn injury was more prominent among those aged <6 years (aHR = 1.96; 95% CI = 1.75-2.20) relative to those aged ≥6 years (aHR = 1.69; 95% CI = 1.56-1.83). Both sexes had similar risk profiles. CONCLUSION: The study findings contribute to the increasing body of evidence that ADHD is associated with proneness to burn injury, particularly in children aged <6 years.
