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Legg-Calvé-Perthes disease and the risk of ADHD, depression and mortality: a register study involving 4057 individuals
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2014 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 85, no 5, p. 501-505Article in journal (Refereed) Published
Abstract [en]

Background and purpose Hyperactive behavior pattern (such as ADHD) is proposed to be present in individuals with LCPD. We investigated whether individuals with LCPD have a higher risk for ADHD, depression and mortality.

Subjects and methods We identified 4057 individuals with LCPD in Sweden during the period 1964-2011. 40570 individuals without LCPD were randomly selected from the Swedish general population and matched by year of birth, sex and region (control group). We used Cox proportional hazard regression to estimate the relative risks.

Results Compared to the control group, individuals with LCPD had a raised hazard ratio (HR) of 1.5 (95% CI 1.2-1.9) for ADHD. The risks were higher for female (HR=2.1, CI: 1.3-3.5) than for male individuals (HR=1.4, CI: 1.1-1.8). Individuals with LCPD had a modestly higher hazard ratio for depression (HR=1.3, CI: 1.1-1.5) than the control group. Furthermore, individuals with LCPD had a slightly higher mortality risk than the control group (HR=1.2, CI: 1.0-1.4)

Interpretation Individuals with LCPD have a higher risk for ADHD. Hyperactivity could expose the femoral head to higher mechanical stress and contribute to the etiology of LCPD. The higher risk for depression might be due to the burden of LCPD itself or could reflect neurobehavioral aspects of ADHD changing into depression later in life. Individuals with LCPD have a higher mortality risk with higher risk of committing suicide and a slightly higher risk of dying of vascular diseases.

Place, publisher, year, edition, pages
2014. Vol. 85, no 5, p. 501-505
Keywords [en]
LCPD, ADHD Depression, Mortality, risk, Epidemiology
National Category
Orthopaedics
Research subject
Orthopaedics
Identifiers
URN: urn:nbn:se:uu:diva-219687DOI: 10.3109/17453674.2014.939015ISI: 000342732200009OAI: oai:DiVA.org:uu-219687DiVA, id: diva2:703807
Available from: 2014-03-09 Created: 2014-03-04 Last updated: 2018-01-11Bibliographically approved
In thesis
1. Legg-Calvé-Perthes Disease – Is it just the hip?: Epidemiological, Clinical and Psychosocial Studies with special focus on Etiology
Open this publication in new window or tab >>Legg-Calvé-Perthes Disease – Is it just the hip?: Epidemiological, Clinical and Psychosocial Studies with special focus on Etiology
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the thesis was to add some pieces to the etiological puzzle of LCPD with special focus on vascular origin and hyperactivity. Furthermore we wanted to evaluate some consequences of LCPD in adulthood.

Swedish registry data were used to identify a cohort of patients with the diagnosis of LCPD. This cohort was compared with a general population– based cohort without LCPD to assess the relative risk of cardiovascular diseases, blood or coagulation defects, injury, ADHD, depression and mortality.

In a clinical study we assessed health-related quality of life (EQ-5D-3L), physical activity level (IPAQ) and screened for ADHD (ASRSv1.1) in 116 patients with a history of LCPD who were diagnosed or treated in Uppsala University Hospital between 1978 and 1995.

The results confirmed our hypothesis: Patients with a history of LCPD had a 1.7-fold higher risk of cardiovascular diseases, and a 1.4-fold higher risk for blood or coagulation defects compared with gender- and age-matched individuals without LCPD. We found a 1.2-fold higher risk for injuries requiring hospital admission than in gender- and age-matched individuals without LCPD. The risk was more pronounced among females. Furthermore, we found a 1.5-fold higher risk for ADHD. Stratified analysis revealed a 2.1-fold higher risk for ADHD among females with LCPD than among females without LCPD. The risk for depression was 1.3-fold higher, and more pronounced among females with LCPD. Patients with LCPD had a slightly higher mortality risk with higher risk for death from suicide and cardiovascular causes.

Patients with a history of LCPD reported a lower health-related quality of life and were more physically active than the Swedish population norm. 28% of 116 patients were likely to have ADHD or had already been diagnosed with ADHD.

Both vascular and blood diseases could be present even in childhood and could, in combination with hyperactive behavior pattern and a high physical activity level, contribute to the etiology of LCPD. The lower health-related quality of life and higher risk for depression might reflect the mental burden of LCPD. Patients with LCPD have a higher mortality risk with higher risk for death from suicide and cardiovascular causes.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. p. 65
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 979
Keywords
Legg-Calvé-Perthes disease, hypertension, ischemic heart disease, coagulation, risk factors, etiology, injury, quality of life, EQ-5D, IPAQ, physical activity, ADHD, ASRS, depression, mortality
National Category
Orthopaedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-219158 (URN)978-91-554-8899-4 (ISBN)
Public defence
2014-04-25, Grönwallsalen, Akademiska Sjukhuset, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2014-04-03 Created: 2014-02-24 Last updated: 2018-01-11Bibliographically approved

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