Background: Although the association of the measles, mumps, and rubella vaccine with autism spectrum disorder has been convincingly disproven, the onset of certain brain-related autoimmune and inflammatory disorders has been found to be temporally associated with the antecedent administration of various vaccines.
This study examines whether antecedent vaccinations are associated with increased incidence of obsessive–compulsive disorder (OCD), anorexia nervosa (AN), anxiety disorder, chronic tic disorder, attention deficit hyperactivity disorder, major depressive disorder, and bipolar disorder in a national sample of privately insured children.
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Study Population
The study sample consisted of children aged 6–15 with a diagnosis of one of the following conditions (ICD-9 codes in parentheses): OCD (300.3), AN (307.1), anxiety disorder (300.0–300.2), tic disorder (307.20 or 307.22), ADHD (314), major depression (296.2–296.3), and bipolar disorder (296.0–296.2, 296.4–296.8). To test the specificity of the models, we also included children with broken bones (800–829) and open wounds (870–897). To identify new cases, we further limited the sample in each diagnostic group to children who were continuously enrolled for at least 1 year prior to their first diagnosis for the condition (the index date). Next, a matched one-to-one control group was constructed for each diagnostic group consisting of children who did not have the condition of interest and were matched with their corresponding case on age, gender, date of the start of continuous enrollment, and three-digit zip code. Because vaccines tend to occur during certain times of year (such as before summer camps or the beginning of school), controls were also required to have an outpatient visit at which they did not receive a vaccine within 15 days of the date that the corresponding case was first diagnosed with the condition, in an effort to control for seasonality. The date of this visit was the index date for children in the control group.
For each diagnostic group and their corresponding controls, individuals who were vaccinated in the 3, 6, or 12 months before the index date were identified. Exposure to vaccines was measured using CPT codes (list available from the authors upon request) and ICD-9 codes (V03–V06 or V07.2). Exposure to specific vaccines, including influenza, tetanus and diphtheria (TD), hepatitis A, hepatitis B, meningitis, and varicella, was tracked.
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