ADHD Pharmacotherapy and Mortality in Individuals With ADHD

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Li, LinKarolinska Institutet (author)

ADHD Pharmacotherapy and Mortality in Individuals With ADHD

Article/chapterEnglish2024

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American Medical Association (AMA),2024
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LIBRIS-ID:oai:DiVA.org:oru-112412
https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-112412URI
https://doi.org/10.1001/jama.2024.0851DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:238470385URI

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Language:English
Summary in:English

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SwePubSwePub

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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IMPORTANCE: Attention-deficit/hyperactivity disorder (ADHD) is associated with increased risks of adverse health outcomes including premature death, but it is unclear whether ADHD pharmacotherapy influences the mortality risk. OBJECTIVE: To investigate whether initiation of ADHD pharmacotherapy was associated with reduced mortality risk in individuals with ADHD. DESIGN,SETTING, AND PARTICIPANTS: In an observational nationwide cohort study in Sweden applying the target trial emulation framework, we identified individuals aged 6 through 64 years with an incident diagnosis of ADHD from 2007 through 2018 and no ADHD medication dispensation prior to diagnosis. Follow-up started from ADHD diagnosis until death, emigration, 2 years after ADHD diagnosis, or December 31, 2020, whichever came first.EXPOSURES: ADHD medication initiation was defined as dispensing of medication within 3 months of diagnosis. MAIN OUTCOMES AND MEASURES: We assessed all-cause mortality within 2 years of ADHD diagnosis, as well as natural-cause (eg, physical conditions) and unnatural-cause mortality (eg, unintentional injuries, suicide, and accidental poisonings).RESULTS: Of 148 578 individuals with ADHD (61 356 females [41.3%]), 84 204 (56.7%) initiated ADHD medication. The median age at diagnosis was 17.4 years (IQR, 11.6-29.1 years). The 2-year mortality risk was lower in the initiation treatment strategy group (39.1 per 10 000 individuals) than in the noninitiation treatment strategy group (48.1 per 10 000 individuals), with a risk difference of -8.9 per 10 000 individuals (95% CI, -17.3 to -0.6). ADHD medication initiation was associated with significantly lower rate of all-cause mortality (hazard ratio [HR], 0.79; 95% CI, 0.70 to 0.88) and unnatural-cause mortality (2-year mortality risk, 25.9 per 10 000 individuals vs 33.3 per 10 000 individuals; risk difference, -7.4 per 10 000 individuals; 95% CI, -14.2 to -0.5; HR, 0.75; 95% CI, 0.66 to 0.86), but not natural-cause mortality (2-year mortality risk, 13.1 per 10 000 individuals vs 14.7 per 10 000 individuals; risk difference, -1.6 per 10 000 individuals; 95% CI, -6.4 to 3.2; HR, 0.86; 95% CI, 0.71 to 1.05).CONCLUSIONS AND RELEVANCE: Among individuals diagnosed with ADHD, medication initiation was associated with significantly lower all-cause mortality, particularly for death due to unnatural causes.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Psykiatri hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Psychiatry hsv//eng

Added entries (persons, corporate bodies, meetings, titles ...)

Zhu, NanboKarolinska Institutet (author)
Zhang, LeDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (author)
Kuja-Halkola, RalfKarolinska Institutet (author)
D'Onofrio, Brian M.Karolinska Institutet (author)
Brikell, IsabellKarolinska Institutet (author)
Lichtenstein, PaulKarolinska Institutet (author)
Cortese, SamueleCentre for Innovation in Mental Health-School of Psychology, Faculty of Environmental and Life Sciences, and Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom; New York University Child Study Center, Hassenfeld Children's Hospital at NYU Langone, New York; Solent NHS Trust, Southampton, United Kingdom; Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Studies of Bari Aldo Moro, Bari, Italy (author)
Larsson, Henrik,1975-Örebro universitet,Institutionen för medicinska vetenskaper(Swepub:oru)hiln (author)
Chang, ZhengKarolinska Institutet (author)
Karolinska InstitutetDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (creator_code:org_t)

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In:Journal of the American Medical Association (JAMA): American Medical Association (AMA)331:10, s. 850-8600098-74841538-3598

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By the author/editor: Li, Lin; Zhu, Nanbo; Zhang, Le; Kuja-Halkola, Ra ...; D'Onofrio, Brian ...; Brikell, Isabell; show more...; Lichtenstein, Pa ...; Cortese, Samuele; Larsson, Henrik, ...; Chang, Zheng; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Psychiatry

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