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.
| Original language | English |
|---|---|
| Pages (from-to) | 824-835 |
| Number of pages | 12 |
| Journal | The Lancet Psychiatry |
| Volume | 5 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 13 Sept 2018 |
Bibliographical note
Publisher Copyright:© 2018 Elsevier Ltd
Funding
SRR reports grants from GlaxoSmithKline, outside the submitted work. KKCM reports personal fees from IQVIA Holdings (previously known as QuintilesIMS Holdings), outside the submitted work. GB reports grants from the National Institute of Mental Health (F31MH107085), during the conduct of the study, and a graduate research assistantship with GlaxoSmithKline, outside the submitted work. SC and SBi report financial support from the Agency for Healthcare Research and Quality (U19SH021112, R18HS03258). EWC reports grants from Research Grant Council (Hong Kong, China), the Beat Drugs Fund of the Narcotics Division, Security Bureau (Hong Kong, China), the National Natural Science Fund of China, Bayer, Bristol-Myers Squibb, Janssen (a division of Johnson and Johnson), Pfizer, and Takeda, outside the submitted work. DC reports grants and personal fees from Shire, grants from Vifor, and personal fees from Eli Lilly, Novartis, and Oxford University Press, outside the submitted work. HK reports that the institution receives fees from Abbvie, Astellas, AstraZeneca, Bayer, Janssen Biotech, Novartis, Pfizer, and Reckitt Benckiser, outside the submitted work. HN reports grants from European Union FP7 programme, during the conduct of the study, and personal fees from Janssen Pharmaceutical KK, outside the submitted work. NLP and EER are members of the Australian Government Drug Utilisation Subcommittee of the Pharmaceutical Benefits Advisory Committee. TS reports other relationships as a member of the Center for Pharmacoepidemiology of the UNC Gillings School of Global Public Health with GlaxoSmithKline, Merck, UCB BioSciences, and Shire and grants from AstraZeneca and Novo Nordisk, outside the submitted work, and that he owns stock in Novartis, Roche, BASF, AstraZeneca, and Novo Nordisk, with none of these companies having any role in the research project. ICKW reports grants from Research Grant Council (Hong Kong, China), Innovative Medicines Initiative, Shire, Janssen-Cilag, Eli Lily, Pfizer, and European Union FP7 programme, outside the submitted work; he was a member of the National Institute of Health and Care Excellence ADHD Guideline group and the British Association for Psychopharmacology ADHD guideline group, and he acted as an advisor to Shire. All other authors declare no competing interests.
| Funders | Funder number |
|---|---|
| Beat Drugs Fund of the Narcotics Division, Security Bureau | |
| FP7 programme | |
| National Institute for Health and Care Research | |
| Vifor | |
| National Institute of Mental Health | F31MH107085 |
| Agency for Healthcare Research and Quality | U19SH021112, R18HS03258 |
| Bristol-Myers Squibb | |
| Pfizer | |
| Bayer Corporation | |
| Johnson and Johnson MSD | |
| Janssen-Cilag | |
| National Natural Science Foundation of China | |
| Research Grants Council, University Grants Committee | |
| SHIRE PHARMACEUTICALS LTD | |
| Seventh Framework Programme | |
| Innovative Medicines Initiative |