关键词: 注意缺陷多动障碍, 患病率, 危险因素, 中国儿童, Meta分析

Abstract: Background Attention deficit hyperactivity disorder (ADHD) has gradually become a public health problem affecting the physical and mental health and personal development of children. There is still a lack of sufficient multi-center and large sample epidemiological studies in China. Understanding the prevalence and risk factors in the past 15 years can provide data reference for disease-related studies, and contribute to early childhood prevention and the establishment of family-school-society intervention mechanisms. Objective To evaluate the prevalence and risk factors of attention deficit hyperactivity disorder (ADHD) in Chinese children in recent 15 years. Methods CNKI, WangFang Data, VIP, SinoMed, Pubmed, Web of Science and Embase databases were searched to collect all the cross-sectional studies on the prevalence of attention deficit hyperactivity disorder in Chinese children and case-control studies and cohort studies related to risk factors from inception to July 2024.. R language 4.4.1 was used for meta-analysis, and the quality evaluation criteria recommended by NOS and AHRQ were used for literature quality evaluation. Literature screening, data extraction, and risk assessment of bias in the included literature were performed independently by 2 researchers. Results 81 literatures were included in this study, with a total of 246 866 children and 20 663 children with ADHD. In recent 15 years, the total prevalence rate of ADHD in Chinese children was 6.2% (95%CI: 5.1%-7.2%), and the prevalence rate of ADHD-I was 3.2% (95%CI: 2.3%-4.2%), which was the main type of disease. The prevalence of boys was 7.6% (95%CI: 6.0%-9.2%) and 3.6% (95%CI: 2.6%-4.5%) in girls. Meta-regression showed that the diagnostic criteria were the main source of heterogeneity, and the prevalence of ADHD with DSM-Ⅳ as the diagnostic criteria was 7.0% (95%CI: 5.7%-8.2%), which was close to the global prevalence. Sensitivity analysis showed that the result was relatively stable, and Egger's test (t=-0.55, P=0.592, > 0.05) showed no significant publication bias.Risk factors for ADHD in Chinese children include male （OR=3.027，95%CI：1.828~5.015，P＜0.01）, family history of ADHD （OR=4.209，95%CI：2.626~6.744，P＜0.01）, maternal mental or emotional abnormalities during pregnancy （OR=2.228，95%CI：1.646~3.017，P＜0.01）, other adverse events during pregnancy （OR=3.306，95%CI：2.699~4.049，P＜0.01）, parental prenatal tobacco exposure （OR=1.929，95%CI：1.650~2.254，P＜0.01）, premature birth （OR=2.031，95%CI：1.586~2.601，P＜0.01）, cesarean section or dystocia （OR=2.889，95%CI：1.647~5.066，P＜0.01）, history of asphyxia at birth （OR=2.917，95%CI：1.232~6.905，P=0.01）, other adverse factors in the perinatal period （OR=3.027，95%CI：2.012~4.553，P＜0.01）, non-exclusive breastfeeding （OR=2.553，95%CI：1.530~4.258，P＜0.01）, non-parental care （OR=1.354，95%CI：1.163~1.575，P＜0.01）, non-nuclear family （OR=2.222，95%CI：1.242~3.976，P＜0.01）, poor parental relationship （OR=2.486，95%CI：1.969~3.139，P＜0.01）, parental emotional instability （OR=1.809，95%CI：1.394~2.347，P＜0.01）, conflicting parenting concepts OR=1.961，95%CI：1.387~2.772，P＜0.01）, and unreasonable educational style （OR=2.809，95%CI：2.285~3.453，P＜0.01）, mother's education below high school （OR=3.325，95%CI：1.904~5.805，P＜0.01）, poor family economic conditions （OR=2.233，95%CI：1.090~4.576，P=0.03）, poor eating habits （OR=1.621，95%CI：1.539~1.707，P＜0.01）, age <3 years when starting video viewing （OR=2.511，95%CI：1.698~3.713，P＜0.01）, history of allergic disease （OR=2.305，95%CI：1.866~2.848，P＜0.01）, high blood lead level （OR=3.073，95%CI：1.336~7.068，P＜0.01）, etc. Conclusion The prevalence rate of attention deficit hyperactivity disorder in China is relatively high, and the gap between the global data is small. The occurrence of the disease is closely related to family demographic characteristics, pregnancy experience, parenting habits and substance exposure, etc. Attention should be paid to the establishment of relevant screening and preventive measures, and more high-quality, multi-center and large sample surveys should be conducted in the future to further explore and verify.

Key words: Attention Deficit Hyperactivity Disorder, Prevalence Rate, Risk Factors, Chinese Children, Meta-analysis