André J McDonald, Paul Kurdyak, Jürgen Rehm, Michael Roerecke, Susan J Bondy
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Due to non-proportional hazards, we estimated age-specific hazard ratios during adolescence (12-19 years) and young adulthood (20-33 years). Sensitivity analyses explored alternative model conditions including restricting the outcome to hospitalizations and ED visits to increase specificity.</p><p><strong>Results: </strong>Compared to no cannabis use, cannabis use was significantly associated with psychotic disorders during adolescence (aHR = 11.2; 95% CI 4.6-27.3), but not during young adulthood (aHR = 1.3; 95% CI 0.6-2.6). When we restricted the outcome to hospitalizations and ED visits only, the strength of association increased markedly during adolescence (aHR = 26.7; 95% CI 7.7-92.8) but did not change meaningfully during young adulthood (aHR = 1.8; 95% CI 0.6-5.4).</p><p><strong>Conclusions: </strong>This study provides new evidence of a strong but age-dependent association between cannabis use and risk of psychotic disorder, consistent with the neurodevelopmental theory that adolescence is a vulnerable time to use cannabis. 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引用次数: 0
摘要
背景:流行病学研究表明,青少年吸食大麻与精神障碍有关。然而,目前的证据主要基于 20 世纪的数据,当时大麻的效力远不如现在:我们将 2009 年至 2012 年的人口调查数据与加拿大安大略省截至 2018 年的全民医疗保健覆盖范围内的医疗服务记录联系起来。队列包括基线年龄为 12-24 岁、之前未患有精神病性障碍的受访者(N = 11 363)。主要结果是根据有效诊断代码得出的与精神病性障碍相关的首次住院、急诊室就诊或门诊就诊天数。由于非比例危害,我们估算了青春期(12-19 岁)和青年期(20-33 岁)的特定年龄危害比。敏感性分析探讨了其他模型条件,包括将结果限制为住院和急诊室就诊,以提高特异性:与不使用大麻相比,青春期使用大麻与精神病性障碍有显著相关性(aHR = 11.2;95% CI 4.6-27.3),但在青年期则没有显著相关性(aHR = 1.3;95% CI 0.6-2.6)。当我们将结果仅限于住院治疗和急诊室就诊时,相关性在青少年时期明显增加(aHR = 26.7; 95% CI 7.7-92.8),但在青年成年期没有明显变化(aHR = 1.8; 95% CI 0.6-5.4):这项研究提供了新的证据,证明吸食大麻与精神失常风险之间存在密切但依赖于年龄的联系,这与神经发育理论一致,即青春期是吸食大麻的脆弱时期。与以往的研究相比,青春期的关联强度明显更大,这可能反映了近期大麻药效的上升。
Age-dependent association of cannabis use with risk of psychotic disorder.
Background: Epidemiologic research suggests that youth cannabis use is associated with psychotic disorders. However, current evidence is based heavily on 20th-century data when cannabis was substantially less potent than today.
Methods: We linked population-based survey data from 2009 to 2012 with records of health services covered under universal healthcare in Ontario, Canada, up to 2018. The cohort included respondents aged 12-24 years at baseline with no prior psychotic disorder (N = 11 363). The primary outcome was days to first hospitalization, ED visit, or outpatient visit related to a psychotic disorder according to validated diagnostic codes. Due to non-proportional hazards, we estimated age-specific hazard ratios during adolescence (12-19 years) and young adulthood (20-33 years). Sensitivity analyses explored alternative model conditions including restricting the outcome to hospitalizations and ED visits to increase specificity.
Results: Compared to no cannabis use, cannabis use was significantly associated with psychotic disorders during adolescence (aHR = 11.2; 95% CI 4.6-27.3), but not during young adulthood (aHR = 1.3; 95% CI 0.6-2.6). When we restricted the outcome to hospitalizations and ED visits only, the strength of association increased markedly during adolescence (aHR = 26.7; 95% CI 7.7-92.8) but did not change meaningfully during young adulthood (aHR = 1.8; 95% CI 0.6-5.4).
Conclusions: This study provides new evidence of a strong but age-dependent association between cannabis use and risk of psychotic disorder, consistent with the neurodevelopmental theory that adolescence is a vulnerable time to use cannabis. The strength of association during adolescence was notably greater than in previous studies, possibly reflecting the recent rise in cannabis potency.
期刊介绍:
Now in its fifth decade of publication, Psychological Medicine is a leading international journal in the fields of psychiatry, related aspects of psychology and basic sciences. From 2014, there are 16 issues a year, each featuring original articles reporting key research being undertaken worldwide, together with shorter editorials by distinguished scholars and an important book review section. The journal''s success is clearly demonstrated by a consistently high impact factor.