Prevalence of somatic diseases in adults with attention deficit hyperactivity disorder in Japan is highest in people aged ≥40 years with mental disorders: a cross-sectional study of a Japanese health insurance claims database

Abstract

Introduction: Studies have reported an association between attention deficit hyperactivity disorder (ADHD) and somatic diseases; however, the correlation of mental disorders with the association between ADHD and somatic diseases remains uninvestigated. This study investigated and compared the prevalence of somatic diseases among adults with/without ADHD, stratified by the presence or absence of mental disorders.

Methods: This cross-sectional study (October 2020-September 2021), using data (June 2013-September 2021) from a Japanese health insurance claims database, included adult participants with a medical record of and receiving medication for ADHD (ADHD group); the control group (matched 1:5 by age/sex) comprised participants without ADHD. The prevalence and odds ratio (OR; ADHD versus control) of type 2 diabetes mellitus (T2DM), diabetes complications, hypertension, cardiovascular disease (CVD), dyslipidemia, gout and hyperuricemia, chronic obstructive pulmonary disease (COPD), non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH), and atopic dermatitis were investigated. Pooled ORs for stratified analysis were calculated using the Mantel-Haenszel method.

Results: In the matched analysis sets, the ORs for all somatic diseases were significantly higher for the ADHD group (n=15,028) versus the control group (n=74,796). On stratified analysis, the Mantel-Haenszel ORs were significant for NAFLD/NASH (1.53; 95% confidence interval [CI]: 1.34, 1.73), diabetes complications (1.39; 95% CI: 1.09, 1.77), and gout and hyperuricemia (1.34; 95% CI: 1.19, 1.51). Furthermore, the stratum-specific ORs for T2DM, hypertension, and dyslipidemia were >1 and <1 in the presence and absence of mental disorders, respectively. The prevalence of all somatic diseases except atopic dermatitis increased with age. For participants aged ≥40 years, the Mantel-Haenszel ORs were significant for all somatic diseases except CVD, COPD, and atopic dermatitis.

Conclusions: The prevalence of several somatic diseases, including chronic disorders, was high among adults with ADHD, particularly in those aged ≥40 years and those with mental disorders.

Keywords: Japan; attention deficit hyperactivity disorder; chronic diseases; health insurance claims database study; mental disorders; observational; somatic diseases; stratified analysis.

Figure 1

Study design. ADHD, attention deficit hyperactivity disorder.

Figure 2

Participant flowchart. ADHD, attention deficit hyperactivity disorder.

Figure 3

Somatic diseases stratified by the presence or absence of mental disorders (matched analysis set). ^*Odds ratio for the ADHD/control group in the matched analysis set, including stratification results. ^**P values in bold font were significant and rejected by the Breslow-Day test. The Mantel-Haenszel odds ratio (Mantel-Haenszel OR) was not indicated if rejected by the Breslow-Day test. ADHD, attention deficit hyperactivity disorder; CI, confidence interval; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; N/A, not applicable; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; T2DM, type 2 diabetes mellitus.

Figure 4

Somatic diseases stratified by the presence or absence of mental disorders in the ≥40 years age category (matched analysis set). ^*Odds ratio for the ADHD/control group in the matched analysis set, including stratification results. ADHD, attention deficit hyperactivity disorder; CI, confidence interval; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; OR, odds ratio; T2DM, type 2 diabetes mellitus.