Moderators of the association between attention-deficit/hyperactivity disorder and exposure to anaesthesia and
Yu Shi1, Hayley J Dykhoff2, Lindsay R H Guevara1
1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Insights
Early anesthesia exposure increases attention-deficit/hyperactivity disorder (ADHD) risk in children. This risk is higher with multiple exposures and in non-White children compared to White children.
Area of Science:
- Pediatric Anesthesiology
- Neurodevelopmental Disorders
- Public Health
Background:
- Childhood exposure to anesthesia has been linked to an increased risk of attention-deficit/hyperactivity disorder (ADHD).
- Understanding potential moderating factors is crucial for risk assessment and prevention strategies.
Purpose of the Study:
- To investigate the association between anesthesia exposure and ADHD diagnosis in children.
- To determine if patient characteristics, such as race and age at exposure, moderate this association.
Main Methods:
- A cohort study included children born between 2006-2012, categorizing anesthesia exposure as unexposed, single, or multiple before age 5.
- Weighted proportional hazard regression analyzed hazard ratios (HRs) for ADHD diagnosis related to anesthesia exposure.
- Interaction analyses identified potential moderators of the anesthesia-ADHD association.
Main Results:
- A cohort of 185,002 children revealed 9,179 ADHD diagnoses.
- Single anesthesia exposure showed a HR of 1.39 (95% CI, 1.32-1.47) for ADHD; multiple exposures showed a HR of 1.75 (95% CI, 1.62-1.87).
- Race was a significant moderator (P=0.006), with higher ADHD incidence in non-White children post-exposure. Age at exposure did not significantly affect the relationship.
Conclusions:
- Anesthesia and surgery exposure in early childhood is associated with increased ADHD incidence, with risk escalating with exposure frequency.
- Non-White children face a disproportionately higher risk of ADHD following anesthesia exposure, warranting further investigation into underlying causes.
Background:
Children's exposure to anaesthesia has been associated with risk of developing attention-deficit/hyperactivity disorder (ADHD). The goal of this study was to determine if selected patient characteristics moderate the association between exposure to anaesthesia and ADHD.
Methods:
In a cohort of children born in between 2006 and 2012, exposure to anaesthesia before the age of 5 yr was categorised into unexposed, singly, or multiply exposed. Weighted proportional hazard regression was performed to evaluate the hazard ratios (HRs) of ADHD diagnosis related to anaesthesia exposure. Interaction analyses were performed to evaluate potential moderators.
Results:
Among 185 002 children in the cohort, 9179 were diagnosed with ADHD. Compared with unexposed children, a single exposure to anaesthesia was associated with a HR of 1.39, (95% confidence interval [CI], 1.32-1.47) for ADHD. Multiple exposures were associated with a HR of 1.75 (95% CI, 1.62-1.87). In the analyses evaluating moderators of the association between exposure and ADHD, only the interaction for race was statistically significant (P=0.006); exposure increased the incidence of ADHD to a greater extent in non-White compared with White children. Among children with a single exposure, the age at exposure did not affect the relationship between exposure and incidence of ADHD (P=0.78).
Conclusions:
Exposure of young children to anaesthesia and surgery is associated with an increased incidence of ADHD, with more exposures associated with greater risk. Compared with White children, non-White children are at greater risk for reasons that are unknown but need to be further explored.
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