注意力不足過動症與城鄉的關聯性

研究背景 : 　　注意力不足過動症是孩童最常見的神經精神疾病，其發生率及盛行率在全球都有上升的趨勢，而此上升現象伴隨著都市化發展的趨勢。目前台灣對於此現象的研究尚且不足，因此，本研究將利用台灣健保資料庫進行孩童注意力不足過動症與城鄉差異的關聯性研究，並且，將對早期使用藥物治療的病人進行用藥模式等分析。研究方法 : 　　本研究為一回溯性，比例1:4配對的橫斷面研究，資料來源為國家衛生研究院2005年百萬歸人檔，資料長度由2000至2010年。本研究最後總共納入4785位年齡小於18歲的新診斷過動症孩童，在經過年齡、性別、診斷日配對後，總共納入19140位非過動症孩童，在次分析中，由主分析納入的過動孩童，排除診斷日後觀察期間不足一年者，共分析4150位新診斷過動症孩童的用藥模式。研究結果 : 　　本研究發現注意力不足過動症和城鄉有顯著關聯性，病人居住在高度都市化地區者，相較於居住在較低度都市化地區者，有1.68倍風險被診斷為注意力不足過動症(95%CI=1.48-1.92)，就藥物治療模式而言，居住在高度都市化地區的病人較不易在診斷完後兩個月內接受藥物治療(Adjusted Odds Ratio (AOR) =0.79; 95%CI=0.65-0.95)。然而，病患是否於診斷完後一年內接受藥物治療與都市化程度高低無關聯性，且用藥持續性也和都市化程度無關聯性。結論 : 　　注意力不足過動症和都市化程度具有關聯性，居住在較高度都市化地區的孩童較易發生此疾病，此外，早期接受藥物治療也和都市化程度具關連性，然而，本研究並未發現用藥的持續性和都市化具有關聯性，未來仍須更長期的研究以釐清本研究所發現的結果。

關鍵字

注意力不足過動症；關聯性研究；都市化；藥物治療；用藥持續性

並列摘要

BACKGROUND: Attention-deficit/ hyperactivity disorder (ADHD) is the most common neuropsychiatric disorder among children. Increasing incidence and prevalence of ADHD globally coincided with the trend of urbanization. In Taiwan, there are few studies focus on this phenomenon. In an attempt to fill the gap, this study aimed to assess the association between ADHD and urbanization by National Health Insurance Research Database (NHIRD) in Taiwan. We further investigated the treatment patterns to give a view of ADHD treatment among Taiwanese children in different urbanized areas. METHODS: This study was a retrospective, 1:4 matched cross-sectional study using Longitudinal Health Insurance Database 2005 (LHID2005) from 2000 to 2010. A total of 4785 newly diagnosed ADHD patients under 18 years old were enrolled in the present study matching with 19140 non- ADHD patients by age, gender and index day. In subgroup analysis, 4150 newly diagnosed ADHD patients were identified to measure the treatment patterns. RESULTS: A significant association between ADHD and urbanization was found in this study. Patients lived in higher urbanized areas had higher risk of ADHD (Adjusted Odds Ratio (AOR) = 1.68; 95%CI=1.48-1.92). In terms of treatment patterns, ADHD patients living in more urbanized areas were less likely to receive pharmacological treatment within two months after diagnosis (AOR=0.79; 95%CI=0.65-0.95). However, receiving pharmacological treatment within one year after diagnosis was not associated with urbanization level. There were also no association detected between medication persistence and urbanization level. CONCLUSIONS: There was a significant correlation between ADHD incidence and urbanization. Individuals living in more urbanized areas were more easily to have ADHD. The negative correlation was also found between the early usages of pharmacological treatment and urbanization level. However, the behavior of medication persistence was not correlated. Long-term studies should be done in the future to clarify the association.

並列關鍵字

attention-deficit/hyperactivity disorder (ADHD) ； association study ； urbanization ； pharmacological treatment ； medication persistence

參考文獻

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注意力不足過動症與城鄉的關聯性

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