Comparative analysis of Attention Deficit Hyperactivity Disorder in China and worldwide based on the Global Burden of Disease study

Abstract

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by difficulties in maintaining attention, excessive activity, impulsive behavior, and challenges in organizing and executing tasks. These symptoms can pose challenges in various settings, including home, school, and work, imposing a significant burden not only on affected individuals and their families but also on the global healthcare system.

Method: This study utilized open data from the Global Burden of Disease database covering the years 1990-2021 to analyze the characteristics of the burden of ADHD in China and worldwide, including incidence, prevalence, and adjusted lifespan for disability (DALYs). The Average Annual Percent Change (AAPC) and the corresponding 95% Confidence Interval (95% CI) were calculated using Joinpoint to reflect the trends in ADHD burden. A comprehensive comparative analysis of the differences in the burden of ADHD between China and the world was conducted in multiple dimensions, such as age and gender, using the R software. Statistical significance was indicated by a two-sided P-value of less than 0.05.

Result: From 1990 to 2021, the age-standardized incidence rate (ASIR) of ADHD in China increased from 103.58 per 100,000 to 126.23 per 100,000, while globally, the ASIR decreased from 61.67 per 100,000 to 58.67 per 100,000. The age-standardized prevalence rate (ASPR) in China increased from 1987.98 per 100,000 to 2183.99 per 100,000, contrasting with the global decline from 1228.35 per 100,000 to 1108.89 per 100,000. The age-standardized DALY rate (ASDR) in China also increased from 24.27 per 100,000 to 26.73 per 100,000, however, it decreased from 14.94 per 100,000 to 13.49 per 100,000 globally. The Average Annual Percent Change (AAPC) for ASIR, ASPR, and ASDR in China were 0.64%, 0.28%, and 0.29%, respectively, indicating an upward trend. In contrast, the global AAPC for the burden of ADHD showed a negative trend, with values of -0.16%, -0.34%, and -0.34% for ASIR, ASPR, and ASDR, respectively. The influence of age and gender on the burden of ADHD is distinct, with the highest incidence, prevalence, and DALYs typically observed during childhood. Furthermore, males consistently demonstrate higher rates across these metrics when compared to females.

Conclusion: While there has been a positive development in reducing the burden of ADHD globally, China faces a significant challenge with increasing rates. The focus on childhood and gender differences is crucial for tailored interventions and policies to address ADHD effectively.

Keywords: Attention Deficit Hyperactivity Disorder; China; Global Burden of Disease; disability-adjusted life years; incidence; prevalence.

Figure 1

The APC of ASIR, ASPR, and ASDR of ADHD in China and globally from 1990 to 2021. (a) The APC of ASIR of ADHD in China; (b) The APC of ASIR of ADHD globally; (c) The APC of ASPR of ADHD in China; (d) The APC of ASPR of ADHD globally; (e) The APC of ASDR of ADHD in China; (f) The APC of ASDR of ADHD globally (* indicates p-values < 0.05 and significant results).

Figure 2

Trend comparison of ASIR, ASPR and ASDR of ADHD in China and worldwide from 1990 to 2021. (a) Trend of ASIR, ASPR and ASDR of ADHD in China; (b) Trend of ASIR, ASPR and ASDR of ADHD globally.

Figure 3

Comparison of the incidence, prevalence, and DALYs rate of ADHD by age group in China and globally for 1990 and 2021. (a) Incidence rate in China, 1990; (b) Incidence rate globally, 1990; (c) Incidence rate in China, 2021; (d) Incidence rate globally, 2021; (e) Prevalence rate in China, 1990; (f) Prevalence rate globally, 1990; (g) Prevalence rate in China, 2021; (h) Prevalence rate globally, 2021; (i) DALYs rate in China, 1990; (j) DALYs rate globally, 1990; (k) DALYs rate in China, 2021; (l) DALYs rate globally, 2021.

Figure 4

Global map of annual percentage change in ADHD-related DALYs per 100,000 for individuals aged 5-14, 1990-2021.

Figure 5

Comparison of the number of incidence, prevalence and DALYs of ADHD in males and females of different age groups in China and globally in 1990 and 2021.

Figure 6

Comparison of full-age cases and age-standardized rates of incidence, prevalence and DALYs among men and women in China and globally from 1990 to 2021.