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Fracture risk and correlating factors of a pediatric population with attention deficit hyperactivity disorder: a
Nai-Wen Guo1, Cheng-Li Lin, Cheng-Wei Lin
1aInstitute of Behavior Medicine, College of MedicinebDepartment of Orthopedics, National Cheng Kung University Hospital, College of MedicinecNCKU Research Center for Health Data and Department of Public Health, National Cheng Kung University, Tainan City, Taiwan.
Insights
Children with attention deficit hyperactivity disorder (ADHD) have a significantly higher risk of fractures compared to their peers. This increased risk is observed across all age groups and sexes, with girls and lower extremities being particularly affected.
Area of Science:
- Pediatric Orthopedics
- Child Psychology
- Epidemiology
Background:
- Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children.
- Fracture risk in children with ADHD has not been extensively studied using large-scale, nationwide data.
- Understanding sex-based differences in fracture risk among children with ADHD is crucial for targeted prevention.
Purpose of the Study:
- To investigate the association between ADHD and fracture risk in children aged 4-17 years.
- To examine sex-specific differences in fracture risk among children diagnosed with ADHD.
- To identify specific body areas and age groups with elevated fracture risk in children with ADHD.
Main Methods:
- Utilized the Taiwanese Longitudinal Health Insurance Database (LHID 2000) covering 96.1% of the population.
- Included 7,200 children diagnosed with ADHD (at least three outpatient visits) and a matched cohort of 36,000 children without ADHD.
- Analyzed fracture incidence rates and hazard ratios (HR) adjusted for age, sex, urbanization, and geographic region.
Main Results:
- Children with ADHD exhibited a significantly higher fracture incidence rate (21.0 per 1000 person-years) compared to non-ADHD children (15.0 per 1000 person-years).
- Adjusted HR for fracture was 1.62 in girls and 1.38 in boys, with higher risks observed in the skull, neck, trunk (1.53), upper extremity (1.28), and lower extremity (1.84).
- The HR increased with age, particularly in older children (10-17 years, HR=1.54), and was highest for lower extremity fractures.
Conclusions:
- ADHD is a significant risk factor for fractures in children across all sexes, age groups, and body areas.
- ADHD girls aged 10 and older face a notably higher fracture risk than ADHD boys.
- Pediatric healthcare providers, parents, and educators should consider ADHD as a critical factor in children's fracture risk assessment and prevention strategies.
Abstract:
The aim of this study was to investigate the risk of fracture and the difference between sexes from a nationwide database of fracture risk among children aged 4-17 years with or without attention deficit hyperactivity disorder (ADHD, ICD-9-CD codes 314). The Longitudinal Health Insurance Database (LHID 2000) was used to analyze fracture characteristics of children from the National Health Insurance that covered 96.1% of the Taiwanese population (N=21.4 million). A total of 7200 ADHD children aged between 4 and 17 years whose diagnosis had been confirmed in at least three outpatient clinics between 1 January 2000 and 31 December 2009 were included, and a cohort of 36 000 children without ADHD matched for age, sex, and urbanization was recruited for analysis. The incidence rate of fractures in ADHD children was 21.0 (95% confidence interval=19.4-22.7) per 1000 person-years, significantly (P<0.001) higher than 15.0 (95% confidence interval=14.4-15.6) in non-ADHDs. After adjusting by age, sex, urbanization level, and geographic region, the statistically significant (P<0.001) hazard ratios (HR) of fracture for ADHD children compared with non-ADHD children included 1.62 in girls and 1.38 in boys, 1.53 in the skull, neck, and trunk (ICD-9-CM 800-809), 1.28 in the upper extremity (ICD-9-CM 810-819), and 1.84 in the lower extremity (ICD-9-CM 820-829). The HR also (P<0.001) increased significantly in all age groups, including 1.35 in 4-6, 1.37 in 7-9, and 1.54 in 10-17 years. ADHD should be listed among risk factors of children's fractures in each sex, all age groups, and all body areas that the parents, teachers, caregivers of ADHD children, and pediatric orthopedists should be aware of. Besides, ADHD girls were more affected than ADHD boys, especially after 10 years of age, whereas the adjusted HR was the highest in the lower extremities. Nationwide analysis matched for age and sex showed that ADHD should be considered the risk factor of children's fracture, especially for girls older than 10 years of age.
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