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Lancet Psychiatry. 2018 Oct;5(10):824-835. doi: 10.1016/S2215-0366(18)30293-1. Epub 2018 Sep 13.

Trends in attention-deficit hyperactivity disorder medication use: a retrospective observational study using population-based databases.

Author information

1
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
2
Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Research Department of Policy and Practice, University College London School of Pharmacy, London, UK; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong, China.
3
Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden.
4
Faculty of Pharmacy, University of Montreal, and CHU Ste-Justine Research Center, Montreal, Quebec, Canada.
5
Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA.
6
Department of Epidemiology, University of North Carolina, Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA.
7
Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
8
School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan.
9
Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
10
Drug Safety Research Unit, Tokyo, Japan.
11
School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan.
12
Research Unit, Social Insurance Institution, Helsinki, Finland.
13
Department of Studies in Public Health, French National Health Insurance, Paris, France.
14
Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, Bordeaux, France.
15
Spanish Agency for Medicines and Medical Devices, Madrid, Spain.
16
Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan.
17
Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark.
18
Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.
19
Spanish Agency for Medicines and Medical Devices, Madrid, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Valencia, Spain.
20
Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Medicines Policy Research Unit, Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
21
Julius Global Health, University Medical Center Utrecht, Utrecht, Netherlands.
22
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
23
Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia.
24
Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. Electronic address: patricip@hku.hk.
25
Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Research Department of Policy and Practice, University College London School of Pharmacy, London, UK. Electronic address: wongick@hku.hk.

Abstract

BACKGROUND:

The use of medications to treat attention deficit hyperactivity disorder (ADHD) has increased, but the prevalence of ADHD medication use across different world regions is not known. Our objective was to determine regional and national prevalences of ADHD medication use in children and adults, with a specific focus on time trends in ADHD medication prevalence.

METHODS:

We did a retrospective, observational study using population-based databases from 13 countries and one Special Administrative Region (SAR): four in Asia and Australia, two in North America, five in northern Europe, and three in western Europe. We used a common protocol approach to define study populations and parameters similarly across countries and the SAR. Study populations consisted of all individuals aged 3 years or older between Jan 1, 2001, and Dec 31, 2015 (dependent on data availability). We estimated annual prevalence of ADHD medication use with 95% CI during the study period, by country and region and stratified by age and sex. We reported annual absolute and relative percentage changes to describe time trends.

FINDINGS:

154·5 million individuals were included in the study. ADHD medication use prevalence in 2010 (in children aged 3-18 years) varied between 0·27% and 6·69% in the countries and SAR assessed (0·95% in Asia and Australia, 4·48% in North America, 1·95% in northern Europe, and 0·70% in western Europe). The prevalence of ADHD medication use among children increased over time in all countries and regions, and the absolute increase per year ranged from 0·02% to 0·26%. Among adults aged 19 years or older, the prevalence of any ADHD medication use in 2010 varied between 0·003% and 1·48% (0·05% in Asia and Australia, 1·42% in North America, 0·47% in northern Europe, and 0·03% in western Europe). The absolute increase in ADHD medication use prevalence per year ranged from 0·0006% to 0·12%. Methylphenidate was the most commonly used ADHD medication in most countries.

INTERPRETATION:

Using a common protocol and data from 13 countries and one SAR, these results show increases over time but large variations in ADHD medication use in multiple regions. The recommendations of evidence-based guidelines need to be followed consistently in clinical practice. Further research is warranted to describe the safety and effectiveness of ADHD medication in the short and long term, and to inform evidence-based guidelines, particularly in adults.

FUNDING:

None.

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