Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study.

By S. Dalsgaard, S. Østergaard, J. Leckman, P. Mortensen, M. Pedersen. The Lancet, 2015

606 citations recorded by the source corpus.

BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a common mental disorder associated with factors that are likely to increase mortality, such as oppositional defiant disorder or conduct disorder, criminality, accidents, and substance misuse. However, whether ADHD itself is associated with increased mortality remains unknown. We aimed to assess ADHD-related mortality in a large cohort of Danish individuals. METHODS By use of the Danish national registers, we followed up 1·92 million individuals, including 32,061 with ADHD, from their first birthday through to 2013. We estimated mortality rate ratios (MRRs), adjusted for calendar year, age, sex, family history of psychiatric disorders, maternal and paternal age, and parental educational and employment status, by Poisson regression, to compare individuals with and without ADHD. FINDINGS During follow-up (24·9 million person-years), 5580 cohort members died. The mortality rate per 10,000 person-years was 5·85 among individuals with ADHD compared with 2·21 in those without (corresponding to a fully adjusted MRR of 2·07, 95% CI 1·70-2·50; p<0·0001). Accidents were the most common cause of death. Compared with individuals without ADHD, the fully adjusted MRR for individuals diagnosed with ADHD at ages younger than 6 years was 1·86 (95% CI 0·93-3·27), and it was 1·58 (1·21-2·03) for those aged 6-17 years, and 4·25 (3·05-5·78) for those aged 18 years or older. After exclusion of individuals with oppositional defiant disorder, conduct disorder, and substance use disorder, ADHD remained associated with increased mortality (fully adjusted MRR 1·50, 1·11-1·98), and was higher in girls and women (2·85, 1·56-4·71) than in boys and men (1·27, 0·89-1·76). INTERPRETATION ADHD was associated with significantly increased mortality rates. People diagnosed with ADHD in adulthood had a higher MRR than did those diagnosed in childhood and adolescence. Comorbid oppositional defiant disorder, conduct disorder, and substance use disorder increased the MRR even further. However, when adjusted for these comorbidities, ADHD remained associated with excess mortality, with higher MRRs in girls and women with ADHD than in boys and men with ADHD. The excess mortality in ADHD was mainly driven by deaths from unnatural causes, especially accidents. FUNDING This study was supported by a grant from the Lundbeck Foundation.

Subfields: Epidemiology, Psychiatry and Mental health, Speech and Hearing

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Citations in the corpus

The World Federation of ADHD International Consensus Statement: 208 Evidence-based Conclusions about the Disorder. (2021, positive): “When ADHD was accompanied by other psychiatric and substance use disorder, the chances of premature death increased (Dalsgaard et al., 2015b).”
ADHD in children and young people: prevalence, care pathways, and service provision. (2017, background): “Studies from European case registers suggest that the discontinuation of pharmacological treatment for ADHD among young men is associated with an increased risk of serious road traffic accidents and criminal convictions;(112,139) and with increased accidents, injuries and emergency department attend”
Genetics of attention deficit hyperactivity disorder (2018, result): “There are, however, some consistent findings in the prior literature, which suggest that people with ADHD are more likely to have larger families [113] and more likely to die prematurely [114].”