: We assessed the association between the use of medications for attention-deficit/hyperactivity disorder (ADHD) and the risk of all-cause mortality and unintentional injuries leading to emergency department (ED) or hospital admission in individuals aged ≤24 years with ADHD. We conducted a population-based retrospective cohort study between 2000 and 2021 using Quebec health administrative data. Individuals were followed from the first ADHD diagnosis or ADHD medication claim until turning 25, death, or study end. Exposure was defined as mutually exclusive episodes of ADHD medication use and/or coverage under the public provincial drug plan (PDP): 1) covered and not treated with ADHD medication; 2) covered and treated with ADHD medication; and 3) not covered under the PDP. The risk of all-cause mortality and unintentional injuries associated with exposure episodes was estimated using multivariable survival analyses. The cohort included n = 217 192 individuals aged 1-24 years with a male to female ratio of close to 2:1. Compared to non-medication use, episodes of ADHD medication use, overall, were associated with reduced all-cause mortality (adjusted hazard ratio, aHR 0.61, 95% CI 0.48-0.76) and unintentional injury leading to ED (0.75, 0.74-0.77) or hospitalisation (0.71, 0.68-0.75). Episodes of stimulants were associated with a lower risk of all-cause mortality and reduced risk of unintentional injuries, while episodes with non-stimulants and with both stimulants and non-stimulants concomitantly were associated with reduced risk of unintentional injuries, but not of all-cause mortality. Although residual confounding cannot be excluded, stimulants may have a protective effect in terms of risk of all-cause mortality and both stimulants and non-stimulants for ADHD may reduce the risk of unintentional injuries. 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.

ADHD medications use and risk of mortality and unintentional injuries: a population-based cohort study / Vasiliadis, Helen-Maria; Lunghi, Carlotta; Rahme, Elham; Rochette, Louis; Gignac, Martin; Massamba, Victoria; Diallo, Fatoumata Binta; Fansi, Alvine; Cortese, Samuele; Lesage, Alain. - In: TRANSLATIONAL PSYCHIATRY. - ISSN 2158-3188. - ELETTRONICO. - 14:1(2024), pp. 128.1-128.7. [10.1038/s41398-024-02825-y]

ADHD medications use and risk of mortality and unintentional injuries: a population-based cohort study

Lunghi, Carlotta
Secondo
Conceptualization
;
2024

Abstract

: We assessed the association between the use of medications for attention-deficit/hyperactivity disorder (ADHD) and the risk of all-cause mortality and unintentional injuries leading to emergency department (ED) or hospital admission in individuals aged ≤24 years with ADHD. We conducted a population-based retrospective cohort study between 2000 and 2021 using Quebec health administrative data. Individuals were followed from the first ADHD diagnosis or ADHD medication claim until turning 25, death, or study end. Exposure was defined as mutually exclusive episodes of ADHD medication use and/or coverage under the public provincial drug plan (PDP): 1) covered and not treated with ADHD medication; 2) covered and treated with ADHD medication; and 3) not covered under the PDP. The risk of all-cause mortality and unintentional injuries associated with exposure episodes was estimated using multivariable survival analyses. The cohort included n = 217 192 individuals aged 1-24 years with a male to female ratio of close to 2:1. Compared to non-medication use, episodes of ADHD medication use, overall, were associated with reduced all-cause mortality (adjusted hazard ratio, aHR 0.61, 95% CI 0.48-0.76) and unintentional injury leading to ED (0.75, 0.74-0.77) or hospitalisation (0.71, 0.68-0.75). Episodes of stimulants were associated with a lower risk of all-cause mortality and reduced risk of unintentional injuries, while episodes with non-stimulants and with both stimulants and non-stimulants concomitantly were associated with reduced risk of unintentional injuries, but not of all-cause mortality. Although residual confounding cannot be excluded, stimulants may have a protective effect in terms of risk of all-cause mortality and both stimulants and non-stimulants for ADHD may reduce the risk of unintentional injuries. 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.
2024
ADHD medications use and risk of mortality and unintentional injuries: a population-based cohort study / Vasiliadis, Helen-Maria; Lunghi, Carlotta; Rahme, Elham; Rochette, Louis; Gignac, Martin; Massamba, Victoria; Diallo, Fatoumata Binta; Fansi, Alvine; Cortese, Samuele; Lesage, Alain. - In: TRANSLATIONAL PSYCHIATRY. - ISSN 2158-3188. - ELETTRONICO. - 14:1(2024), pp. 128.1-128.7. [10.1038/s41398-024-02825-y]
Vasiliadis, Helen-Maria; Lunghi, Carlotta; Rahme, Elham; Rochette, Louis; Gignac, Martin; Massamba, Victoria; Diallo, Fatoumata Binta; Fansi, Alvine; Cortese, Samuele; Lesage, Alain
File in questo prodotto:
File Dimensione Formato  
Vasiliadis et al. TransPsychiatry 2024.pdf

accesso aperto

Tipo: Versione (PDF) editoriale
Licenza: Licenza per Accesso Aperto. Creative Commons Attribuzione (CCBY)
Dimensione 462.93 kB
Formato Adobe PDF
462.93 kB Adobe PDF Visualizza/Apri
41398_2024_2825_MOESM1_ESM.docx

accesso aperto

Tipo: File Supplementare
Licenza: Licenza per Accesso Aperto. Creative Commons Attribuzione (CCBY)
Dimensione 75.46 kB
Formato Microsoft Word XML
75.46 kB Microsoft Word XML Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/965186
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 1
  • ???jsp.display-item.citation.isi??? 1
social impact