Keypoint: All-cause mortality risk was lower with stimulant – but not nonstimulant – ADHD medication use.
Among individuals with attention-deficit/hyperactivity disorder (ADHD), ADHD medication use is associated with a reduced risk for all-cause mortality and unintentional injuries leading to emergency department (ED) visits, according to study results published in Translational Psychiatry.
Previous research has established that ADHD is associated with adverse health outcomes and comorbidities. Although ADHD medications are efficacious in treating ADHD symptoms, relatively little is known about how these medications – both stimulants and nonstimulants – affect mortality and unintentional injuries.
To address this knowledge gap, researchers conducted a population-based cohort study using health administrative data in Quebec, Canada. The study evaluated mortality and injury outcomes among individuals with ADHD who were aged 24 years and younger between April 1, 2000, and March 31, 2021. Eligible participants had a physician claim or hospital diagnosis of ADHD. Additionally, the researchers used prescription data to verify ADHD medication use for amphetamine or methylphenidate-based stimulants and nonstimulants. Participants were followed until emigration, death, 25 years of age, or the conclusion of the study.
The researchers identified 217,192 participants with ADHD. At study start, 64.2% of the participants were 11 years of age and younger when first diagnosed with ADHD, 64.1% were boys, and 78.5% had a comorbid mental or substance use disorder.
The researchers found that the average all-cause mortality rates per 1000 person-years for individuals with ADHD were notably lower during episodes of ADHD medication use (0.26; 95% CI, 0.21-0.32) relative to periods without ADHD medication (0.48; 95% CI, 0.44-0.53). The average rate of injuries leading to ED visits per 1000 person-years was also reduced when individuals were using ADHD medications (91.0; 95% CI, 90.1-91.9) compared with episodes of nonuse (98.3; 95% CI, 97.7-99.0). Hospitalizations due to unintentional injuries showed similar patterns, as the average rates per 1000 person-years were 8.7 (95% CI, 8.5-8.8) without ADHD medication and 7.4 (95% CI, 7.2-7.7) with ADHD medication.
These findings were confirmed in hazard ratio models, as the researchers found a reduced risk for all-cause mortality (adjusted hazard ratio [aHR], 0.61; 95% CI, 0.48-0.76) during episodes of ADHD medication use relative to nonuse. This risk reduction was observed during periods of stimulant use alone (aHR, 0.61; 95% CI, 0.48–0.77), but the risk was not reduced with the use of nonstimulants or a combination of stimulants and nonstimulants.
The researchers also found that ADHD medication use decreased the risk for unintentional injuries leading to ED admissions (aHR, 0.75; 95% CI, 0.74-0.77) and hospitalizations (aHR, 0.71; 95% CI, 0.68-0.75). This risk reduction was robust across both stimulant and nonstimulant use across both outcomes.
Regarding, ADHD medication use also showed a decreased risk with an) compared with no medication use under the public drug plan. This protective effect was similarly observed with stimulant use (aHR 0.76; 95% CI, 0.75–0.77), nonstimulant use (aHR, 0.77; 95% CI, 0.73–0.81), and combined use of stimulants and nonstimulants (aHR, 0.66; 95% CI, 0.62–0.70).
The researchers concluded, “The findings of the current study should inform clinical decision making on the choice of starting a pharmacological treatment for ADHD, when a balance needs to be struck between expected benefits and possible risks.”
Study limitations include the reliance on prescription claims for ADHD medication use (without verifying medication adherence), potential residual confounding, and a lack of generalizability to other populations or healthcare systems.
Note: This article originally appeared on Psychiatry Advisor
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