Cohort Definition Name : First event of Attention-deficit hyperactivity (ADHD) disorder or procedure
Contributor name : Jamie Weaves’, ‘Mitch Connover’
Contributor OrcId :
Logic Description : First occurrence of Attention-deficit hyperactivity disorder (ADHD) condition or related procedures, indexed on the earliest occurrence of ADHD condition, procedure or treatment (limited to drug exposure followed by a related condition or procedure), with 365d prior observation, exit at end of observation
Recommended study application : target
Assertion statement : This cohort definition was executed on at least one real person-level observational health data source and resulted in a cohort with at least 1 person.
Target Clinical Description : Attention deficit hyperactivity disorder (ADHD) is a disorder that manifests in childhood with symptoms of hyperactivity, impulsivity, and/or inattention. The symptoms affect cognitive, academic, behavioral, emotional, and social functioning. The 2015-2016 prevalence of ADHD among children aged 4 to 17 years of age in the United States was 10 percent. This is an increase from 6 percent in 1997 to 1998. The prevalence increased with increasing age (7.7 percent among 4- to 11-year-olds and 13.5 percent among 12- to 17-year-olds). Studies have found that a majority of people diagnosed with ADHD in childhood continue to be significantly impaired as adults. ADHD is more common in males than females. In the 2015 to 2016 NHIS, the prevalence was 14 percent in males and 6 percent in females. The male to female ratio is 4:1 for the predominantly hyperactive type and 2:1 for the predominantly inattentive type.
"Evaluation conclusion : This cohort definition is defined using ADHD condition, procedure, and medication concept sets curated from the literature, prior work, and syntax analysis of orphan concepts using the PHOEBE tool. We selected this phenotype based on 1) its superior performance characteristics as estimated by PheValuator, 2) evidence of acceptable performance across the data network, including general-practice based databases (where other more restrictive definitions performed poorly), 3) evidence that it reduces index date misclassification, 4) stable incidence overtime in a broad number of databases.
We performed the evaluation across a network of claim data sources and 1 EHR US data source. The data sources are: IBM® MarketScan® Commercial Database (CCAE), Optum’s longitudinal EHR repository (Optum EHR), Optum’s Clinformatics® Data Mart (DOD), IBM® MarketScan® Multi-State Medicaid Database (MDCD), IBM® MarketScan® Medicare Supplemental Database (MDCR), Japan Claims Database (JMDC), Clinical Practice Research Datalink (CPRD) , IQVIA® Australia Longitudinal Patient Data (LPD) database (Australia), IQVIA® Disease Analyzer (DA) France database (France), QVIA® Disease Analyzer (DA) Germany database (Germany), IQVIA® Adjudicated Health Plan Claims Data (formerly PharMetrics Plus) - US database (PharMetrics), IQVIA® Ambulatory EMR (EMR). The algorithm retrieves subjects from all databases tested and exhibits strong/acceptable performance characteristics as estimated by PheValuator. We note limitations around using this phenotype including the (by our assessment, low) potential for immortal time bias when it is used as a target cohort in an incidence rate analyses. We also note that this phenotype also exhibits slightly worse sensitivity in databases drawing from general practitioner data (FRA, GER). Overall, the sensitivity ranged from 0.64 to 0.98 and PPV ranged from 0.88 to 0.98.