TY - JOUR
T1 - Moderators of the association between attention-deficit/hyperactivity disorder and exposure to anaesthesia and surgery in children
AU - Shi, Yu
AU - Dykhoff, Hayley J.
AU - Guevara, Lindsay R.H.
AU - Sangaralingham, Lindsey R.
AU - Schroeder, Darrell R.
AU - Flick, Randall P.
AU - Zaccariello, Michael J.
AU - Warner, David O.
N1 - Publisher Copyright:
© 2021 British Journal of Anaesthesia
PY - 2021/11
Y1 - 2021/11
N2 - 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.
AB - 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.
KW - age
KW - anaesthesia
KW - attention-deficit/hyperactivity disorder
KW - children
KW - moderator
KW - paediatric anaesthesia
KW - race
UR - http://www.scopus.com/inward/record.url?scp=85114476725&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85114476725&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2021.07.025
DO - 10.1016/j.bja.2021.07.025
M3 - Article
C2 - 34503832
AN - SCOPUS:85114476725
SN - 0007-0912
VL - 127
SP - 722
EP - 728
JO - British journal of anaesthesia
JF - British journal of anaesthesia
IS - 5
ER -