Mortality in People with ADHD [pdf]

http://www.nice.org.uk/Media/Default/newsletter/Eyes-on-Evidence-September-2015.pdf

by DanBC • 11 years ago

42 35 11 years ago

nice.org.uk

adamrights• 11 years ago

Yes, impulsive, creative, wild, dangerous, bored people doing riskier things have 2x mortality. There's a lot of things that'll increase it a lot more -- like different geolocations.

lighthawk• 11 years ago

I agree that this shouldn't be a surprise. What I'm more interested in is whether the medication used to treat ADD/ADHD could have an adverse health effect that would reduce lifespan, i.e. if they ignore accidental deaths completely, will those on ADD/ADHD meds live just as long as those that do not take those meds?

lfowles4• 11 years ago

For stimulants: increased blood pressure. I've had to switch several times because I wasn't able to get to an effective dose without sitting firmly in prehypertension bp levels.

wjnc• 11 years ago

A thing with this study is that they measure survival mostly in an age bracket with relatively low chance of death, but also in a bracket where chances of death by accidents due to lifestyle are relatively high.

A base death rate of 2.2 per 10k years is one per 4500 years. Since you live about 80 years, the sample is skewed towards the not-so-likely to die. Perfectly acceptable btw, but it makes inferences to what happens to the life expectancy Curve harder.

My prior would be: the cumulative survival curve for ADHD is markedly lower in the ages 5-30s (one dies more often when at risk due to accidents), and then converging to the curve UNLESS the medicines are harmful as well.

My point in other words: aMRR is a fine measure, but you really want to identify causes to shifts in (parts of) the survival function. For now it's a finding that just confirms prior beliefs.

[edit] Confirmation by the same author [1]. All that would be cool now is estimates of survival functions. They must have some people in their dataset dying of old age.

"Children with ADHD had an increased risk of injuries compared with other children. Treatment with ADHD drugs reduced the risk of injuries by up to 43% and emergency ward visits by up to 45% in children with ADHD. Taken together with previous findings of accidents being the most common cause of death in individuals with ADHD, these results are of major public health importance."

[1] http://pure.au.dk/portal/en/persons/soeren-dalsgaard(9da0473...

danellis3• 11 years ago

I think I probably have ADHD, and this didn't surprise me. One of the symptoms appears to be a problem with executive function where there's a disconnect between recognizing risk and taking appropriate action to mitigate it. So many times I find myself cursing my stupidity when some foreseen accident actually ends up happening. Fortunately, as you might have already assumed, it hasn't been fatal yet.

jasonlotito• 11 years ago

I think I probably have ADHD

Do not think, know. Get checked and officially diagnosed. Otherwise, you are doing yourself and others harm. We test code, we should test ourselves.

unfasten• 11 years ago

    All-cause mortality was 5.85 per 10,000 person–years among people 
    with ADHD, compared with 2.21 per 10,000 person–years in people without ADHD. The risk of death 
    among people with ADHD was more than double that in the general population (adjusted mortality rate 
    ratio [MRR]=2.07, 95% confidence interval [CI] 1.70 to 2.50, p<0.0001).

They then give the mortality rates for those diagnosed with ADHD another disorder or substance misuse issues:

    Age at diagnosis of ADHD was associated with mortality, with the risk of death highest among people 
    diagnosed in adulthood (adjusted MRR=4.25, 95% CI 3.03 to 5.78). Mortality among people with ADHD 
    was also affected by comorbid oppositional defiant disorder or conduct disorder (adjusted MRR=2.17, 
    95% CI 1.33 to 3.31) and by coexisting substance misuse (adjusted MMR=5.63, 95% CI 3.69 to 8.16). 
    Among people without these comorbid conditions, mortality was higher in girls and women with ADHD 
    (adjusted MRR=2.85, 95% CI 1.56 to 4.71) than in boys and men (MRR=1.27, 95% CI 0.89 to 1.76).

The part I found interesting here, that they don't seem to mention elsewhere in this article, is that the mortality rate for males with ADHD but without the other disorders is actually lower than their general population numbers (2.07 general population vs 1.27 for males without one of those issues). They actually seem to completely ignore it:

    “Even if these complications did not develop, ADHD was still a risk factor for mortality. This could well be 
    because the core problem of impulsiveness is a cause of accidents, and accidents were the major cause 
    of death.

I'm going by the adjusted mortality rate ratio number. If I'm reading this wrong, please let me know.

Menge• 11 years ago

(2.07 general population vs 1.27 for males without one of those issues)

Since substance misuse and the other disorders influence mortality rates of the ADHD population, it is not surprising that they affect mortality in the general population.

For the inference you seem to be making, I think you would need the mortality rate of males with no ADHD AND no substance misuse/etc. Based on the data given, I see no reason to think that is above 1.27.

pasbesoin• 11 years ago

I'm just going to requote those excerpts with flowing text:

All-cause mortality was 5.85 per 10,000 person–years among people with ADHD, compared with 2.21 per 10,000 person–years in people without ADHD. The risk of death among people with ADHD was more than double that in the general population (adjusted mortality rate ratio [MRR]=2.07, 95% confidence interval [CI] 1.70 to 2.50, p<0.0001).

Age at diagnosis of ADHD was associated with mortality, with the risk of death highest among people diagnosed in adulthood (adjusted MRR=4.25, 95% CI 3.03 to 5.78). Mortality among people with ADHD was also affected by comorbid oppositional defiant disorder or conduct disorder (adjusted MRR=2.17, 95% CI 1.33 to 3.31) and by coexisting substance misuse (adjusted MMR=5.63, 95% CI 3.69 to 8.16). Among people without these comorbid conditions, mortality was higher in girls and women with ADHD (adjusted MRR=2.85, 95% CI 1.56 to 4.71) than in boys and men (MRR=1.27, 95% CI 0.89 to 1.76).

“Even if these complications did not develop, ADHD was still a risk factor for mortality. This could well be because the core problem of impulsiveness is a cause of accidents, and accidents were the major cause of death.

netcan• 11 years ago

I think the vocabulary we use is starting to rub up against its limitations in problematic ways. Medicine is ver geared towards a pathology-diagnosis-treatment paradigm.

When it comes to something like blood pressure that's decent enough. Blood pressure above a certain threshold significantly increases the risks of XYZ and therefore… There are edge cases and grey areas that come from drawing a circle around anything that doesn't naturally conform to categorization, but the paradigm works.

For other things, the paradigm is clunkier. For one thing, doctors have an ethical (and legal, institutional..) objection to intervention unless some "pathology" criteria has been met. Since people want to use treatment and/or sell it, the definition of the pathology is constantly being messed with to conform.

Consider viagra. According to some, it is a pathology in young men but natural in older men. In any case, viagra is allowed to be prescribed. But then, impotence is on a scale. You are not allowed to use the drug unless you fall within some diagnostic parameters. There is no framework for "elective" use. You 22 year olds cannot have it. But, it's probably less harm to a robust 22 year old then a 55 year old.

Anyway, ADHD is something that tends to be diagnosed in children when they exhibit some problematic behavior, usually problematic to schools and sometimes at home. It sticks as a diagnosis when the treatment works.

So, your sample here is largely kids that had behavioral problems for which some sort of intervention (ritalin, meditation, diet..) was sought.

It's almost like saying teenagers expelled for drinking at school are more likely to default on rent in their 40s. It might mean that drinking during formative years affects your financial responsibility, but it probably means that teenager who get into trouble often grow into adults who get into trouble.

therobot24• 11 years ago

I was with you until the last line:

but it probably means that teenager who get into trouble often grow into adults who get into trouble.

I don't need to be the one to disprove it because the loose terminology is just so ludicrous. You're clumping ADHD in with sooo many other outside factors that influence what is 'trouble' and it's causes.

atemerev3• 11 years ago

After losing my passport three weeks ago for the third time (together with a brand new MacBook I bought a few days earlier) and dooming myself to months of documents recovery in two countries I live in, yes, I sometimes just want to f* die.

Life with ADHD is hard.

JohnBooty2• 11 years ago

I feel you. Wishing you luck!

geoelectric3• 11 years ago

FWIW, some credit cards (at least in the US) have loss protection for recent purchases made on them. Might be worth checking into.

antihero• 11 years ago

Also everyone I know with ADHD, myself included, goes really really fucking hard at parties and substances. To the point where we put our bodies at massive risk. I'm working at trying to train out the stupidity but it's hard.

atemerev3• 11 years ago

Well, I am not much of a partygoer, and the only substances are take is my ADHD prescription drugs (which are bona fide "substances", so I doubt I need anything else among these lines).

chris_wot2• 11 years ago

I don't have that issue and never have. But my impulse control is often poor - it's pretty freaking awful. Luckily for me it just means I tend to say too much, although this can have devastating consequences.

JohnBooty2• 11 years ago

If nothing else, I hope that studies like this help people to realize that ADHD is a real thing.

reilly3000• 11 years ago

My mother always warned me to maintain focus or I will walk in front of a bus. Yet she denies to this day I have ADHD (would make her look bad???). After a lifetime thus far of poor coordination, constantly losing things, awkward social interaction and rarely finishing projects, I've come to terms with it. ADHD is associated with risky driving, dangerous misuse of power tools, other 'short cut' behaviors that undermine safety of adhd people and those around them. It IS a public health issue for that reason yet awareness is low.

chris_wot2• 11 years ago

My anxiety levels are off the charts and I sometimes have suicidal thoughts. I wonder how many ADHD people commit suicide?

Mortality in People with ADHD [pdf]

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