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ADHD Pharmacotherapy and Mortality in Individuals With ADHD
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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2024 (English)In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 331, no 10, p. 850-860Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
American Medical Association (AMA), 2024. Vol. 331, no 10, p. 850-860
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-112412DOI: 10.1001/jama.2024.0851ISI: 001217012900004PubMedID: 38470385Scopus ID: 2-s2.0-85187789072OAI: oai:DiVA.org:oru-112412DiVA, id: diva2:1845567
Funder
Ekhaga Foundation, 2021-59Olle Engkvists stiftelse, 218-0049Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-01172; 2022-01111EU, Horizon 2020, 965381Available from: 2024-03-19 Created: 2024-03-19 Last updated: 2024-05-24Bibliographically approved

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