A recently published observational cohort study explored whether initiation of attention deficit hyperactivity disorder (ADHD) pharmacotherapy was associated with reduced mortality risk in individuals with ADHD by comparing those who were treated with ADHD medication against those who were not..

The observational study was conducted in Sweden utilized a target trial emulation approach and tracked the health of 148,578 individuals with ADHD. Of these people, 41.3% were female (n= 61?356). The median age of those included in the study was 17.4 years, and the overall age range was 6 to 64. A total of 84,204 (56.7%) of the study participants initiated ADHD medication (initiation treatment strategy group), while 64,296 did not take medication within that period (non-initiation treatment strategy group). ADHD medication initiation was defined as dispensing of medication within 3 months of diagnosis. Each individual in both groups was followed for two years after diagnosis. The medications involved in the study were the six that were licensed in Sweden for the treatment of ADHD from 2007 to 2020: methylphenidate, amphetamine, dexamphetamine, lisdexamfetamine, atomoxetine, and guanfacine. The researchers recorded all-cause deaths, as well as deaths from unnatural causes associated with ADHD (examples, accidents, suicide, accidental poisoning, or drug overdose).

Study results showed that the two-year mortality risk was lower in the initiation treatment strategy group (39.1 per 10?000 individuals) than in the non-initiation treatment strategy group (48.1 per 10?000 individuals). Researchers reported that initial dispensation of ADHD medication was significantly associated with lower all-cause (hazard ratio [HR], 0.79; 95% CI, 0.70 to 0.88) and unnatural-cause mortality (hazard ratio [HR], 0.75; 95% CI, 0.66 to 0.86). However the association with natural-cause mortality was not significant (hazard ratio [HR], 0.86; 95% CI, 0.71 to 1.05).

Additionally, the initiation of ADHD medication was associated with a lower risk of all-cause and unnatural-cause mortality in males. In females, the only observed statistically significant association was between initiation of ADHD medication and natural-cause mortality. The researchers called for further exploration of any sex difference in the relationship between ADHD treatment and mortality to optimize outcomes for both males and females with ADHD. The researchers also highlighted how untreated ADHD increases the likelihood of engaging in risky behaviors, leading to fatal accidents, smoking, and drug addiction.

Reference:

Li L et al. JAMA. 2024;331(10):850-860. Abstract