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

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

Original languageEnglish
Article number787745
JournalFrontiers in Medicine
Early online date8 Feb 2022
Accepted/In press24 Dec 2021
E-pub ahead of print8 Feb 2022
Published8 Feb 2022

Bibliographical note

Funding Information: This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health, and managed by the Taiwan National Health Research Institutes, Republic of China. The authors thank the Health Information and Epidemiology Laboratory (CLRPG6G0041) for their comments and assistance in data analysis. Funding Information: This study was supported by grants from the Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan (Grant Number: CMRPG6E0271). S-IW is part-funded by the Department of Medical Research, Mackay Memorial Hospital (MMH-109112, MMH-10914, MMH-108121, MMH-108146, MMH-TT-10804, and MMH-TH-10804). Publisher Copyright: Copyright © 2022 Chen, Kao, Chen, Wu, Lee and Gossop.


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Objective: Children 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. Method: The 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. Results: Children 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 Relevance: This 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.

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