A large systematic review and meta-analysis has found that people with an attention deficit hyperactivity disorder (ADHD) diagnosis have a 70% higher rate of death from all causes compared with people who do not have the condition.
The study, published in JAMA Network Open, involved researchers from University College London and the University of Liverpool in the United Kingdom analyzing data from nearly 16 million people.
ADHD is a condition that affects a person’s attention, energy levels, and impulse control. According to the Centers for Disease Control and Prevention (CDC), around 15.5 million adults in the United States currently have ADHD.
Research has firmly established that, without management, ADHD can lead to problems with relationships, work, and education. Previous studies have also noted an association between ADHD and living shorter lives.
“We have previously found that people with ADHD have reduced life expectancies, so here we are adding to our understanding of what drives this very concerning statistic,” said senior author Joshua Stott, PhD, in a press release.
The research team looked at data from a total of 19 longitudinal cohort studies. These involved 15,920,970 participants — of whom 36.1% were female — spread across North America, Europe, and Asia.
Some of the studies the researchers selected for review followed their cohorts for up to 20 years.
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The researchers analyzed the data to see if they could find any associations between ADHD, the use of ADHD medication, and mortality.
They looked at both mortality from all causes as well as the death rates associated with some specific causes. The specific causes were suicide, unintentional or intentional injuries, and natural causes.
Overall, the researchers found that having ADHD was associated with a 70% higher risk of mortality due to all causes compared with people who did not have ADHD.
The association between ADHD and a higher risk of death varied between different causes. The associated increases were:
“We found that people with ADHD face an increased risk not only of death by suicide and injury, but also of deaths by natural causes, adding to evidence that health inequalities faced by people with ADHD are broad and wide-ranging,” said Stott in the press release.
Medical News Today spoke with first author Lucy Corrigan of the University of Liverpool, who described the association between ADHD and mortality by natural causes as “somewhat surprising.”
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“This does not mean that ADHD directly causes these deaths, but it suggests that the health risks experienced by people with ADHD may extend beyond accidents and suicide,” Corrigan said.
She noted that while the findings of the different studies analyzed generally pointed in the same direction, the strength of the association varied between studies.
“This may reflect differences in the populations studied, healthcare systems, and how the studies were carried out,” she told MNT. “These differences highlight the importance of considering the wider context when interpreting the findings.”
While rates of death were higher for those with ADHD, the researchers also saw that ADHD medication could reduce the risks.
Among those with ADHD, participants who received medication to treat it had a 25% lower risk of mortality from all causes compared with those who did not have medication.
Only three studies specifically looked at ADHD medication, however, meaning that the amount of available data with which to assess this association was limited.
“Our findings provide early evidence to suggest that medication may play an important role in supporting the health of people with ADHD, but this is based on a small number of studies and further research is needed to clarify this link,” said Corrigan in the press release.
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“And medication is just part of the story; many people with ADHD benefit from comprehensive, long-term treatment and support,” she added.
The researchers wrote that the reasons behind the associated increases in death differed from cause to cause.
For death by suicide, they noted that this may be due to people with ADHD also experiencing higher rates of mental health issues such as depression, substance use disorders, and social exclusion.
ADHD is also associated with an increased risk of being involved in traffic accidents, which may be one factor in the higher rates of death from injury. The previously mentioned increased risk of substance use disorder may also come with its own risk of unintentional harm.
Finally, the higher rates of death from natural causes may be related to an association between ADHD and increased risks of smoking, poor diet, and sleep problems, as well as certain conditons, such as cardiovascular diseases.
Further, the researchers note that difficulties with attention and organization could make it harder for people to follow medical treatment plans or to fully engage with healthy practices.
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The researchers believe that their findings indicate that many people with ADHD are not receiving the support they need.
“ADHD is not by definition a life-limiting condition as the right support and treatment can help people with ADHD to live long and healthy lives,” said Stott in the press release.
“Our findings underscore the importance of ensuring that everyone who may have ADHD has access to accurate diagnosis and treatment,” he added.
The researchers note that more research is needed to look closely at the potential impact of being female, a historically marginalized race or ethnicity, and childhood mistreatment on mortality risks.
They also note that there is a gap between rates of diagnosis and prevalence in the general population.
“While ADHD diagnosis rates have risen in recent years, they may still lag behind actual prevalence, particularly for older age groups where mortality risk may be most pertinent,” said Stott in the press release.
As a result, the findings underline a real need to increase access to diagnosis and treatment for people who may have the condition.
“Many people with ADHD face challenges throughout their lives, so equitable access to evidence-based assessment and treatment is vital to ensure they can live long, healthy lives,” added senior author Amber John, PhD, in the press release.
MNT also spoke with Sylvia Baker, MRCpsych, consultant psychiatrist at Re:Cognition Health, who was not involved with the study. Baker explained that as people with ADHD get older, their support needs may become more complex.
“While educational adjustments are important earlier in life, adults may need ongoing support with employment, relationships, emotional regulation, physical health, and managing co-occurring conditions such as anxiety and depression,” she said.
“Difficulties with organisation and access to healthcare can also affect long-term well-being,“ added the psychiatrist.
“The findings reinforce the importance of timely diagnosis, appropriate treatment, and continued, individualized support throughout adulthood, rather than assuming ADHD is a childhood condition that no longer requires attention later in life.”
– Sylvia Baker, MRCpsych
