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ADHD Medication Use May Lower Mortality
Medication initiation in patients with attention-deficit/hyperactivity disorder (ADHD) was associated with significantly lower all-cause mortality, according to recent results from an observational nationwide cohort study published in JAMA.
“ADHD medication may reduce the risk of unnatural-cause mortality by alleviating the core symptoms of ADHD and its psychiatric comorbidities, leading to improved impulse control and decision-making, ultimately reducing the occurrence of fatal events, in particular among those due to accidental poisoning,” noted first author Lin Li, PhD, Karolinska Institutet, Stockholm, Sweden, and co-authors.
Related: Adults With ADHD Report 'Camouflaging' Their Symptoms
Using data from multiple national registries, researchers identified people in Sweden ages 6 through 64 years who had an incident diagnosis of ADHD from 2007 to 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. To evaluate the effect of ADHD medication initiation on mortality risk, authors used the target trial emulation approach.
A total of 148,578 participants with ADHD were included, 41.3% of which were female. Researchers found that the median age at diagnosis for individuals with ADHD was 17.4 years. Those who initiated ADHD medication treatment had a lower 2-year mortality risk compared to those who did not initiate treatment (39.1 per 10,000 individuals and (48.1 per 10,000 individuals, respectively). ADHD medication initiation was associated with a significantly lower rate of all-cause mortality (hazard ratio [HR], 0.79; 95% CI, 0.70 to 0.88) and unnatural-cause mortality (HR, 0.75; 95% CI, 0.66 to 0.86), but not natural-cause mortality (HR, 0.86; 95% CI, 0.71 to 1.05).
Authors acknowledged the following study limitations.
- Because the study was observational, findings cannot definitively establish a causal relationship between ADHD medication treatment and mortality risk due to potential unmeasured confounders like lifestyle factors. Additionally, ADHD treatment encompasses more than just medication, including social support, which could influence outcomes.
- The possibility of type I errors from multiple comparisons and subgroup analyses suggests that these findings should be seen as exploratory rather than definitive..
- Exposure misclassification due to inconsistent medication adherence might underestimate true effects.
- Misclassification of causes of death like suicide or accidental poisoning is possible due to uncertain intent.
Despite these limitations, authors discussed the key strengths of the study’s findings. “To our knowledge, this study is the first target trial emulation study using real-world data in ADHD research. Additional strengths are the long follow-up time, validated measures on exposure and outcome in a nationwide sample, and a broad age range that enabled the exploration of the association in both children and adults,” researchers concluded.
