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    Original Investigation
    August 7, 2019

    Attention-Deficit/Hyperactivity Disorder and Mortality Risk in Taiwan

    Author Affiliations
    • 1Department of Psychiatry, Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital at Chiayi, Puzi, Taiwan
    • 2Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
    • 3Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
    • 4Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
    • 5Department of Psychiatry, Mackay Memorial Hospital, New Taipei City, Taiwan
    • 6Department of Neurology, Chang Gung University and Chang Gung Memorial Hospital at Chiayi, Puzi, Taiwan
    • 7Department of Psychiatry, Wan-Fang Hospital, Taipei, Taiwan
    • 8School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
    • 9Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
    • 10South London and Maudsley NHS Foundation Trust, London, United Kingdom
    • 11Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
    JAMA Netw Open. 2019;2(8):e198714. doi:10.1001/jamanetworkopen.2019.8714
    Key Points español 中文 (chinese)

    Question  Is attention-deficit/hyperactivity disorder (ADHD) associated with higher early mortality risk among patients in Taiwan?

    Findings  In this Taiwan nationwide population-based cohort study, there were 275 980 patients with ADHD and 1 931 860 matched controls. After adjustment for potential confounders, patients with ADHD had significantly elevated early mortality risk for suicide, homicide, and unintentional injuries compared with the non-ADHD group.

    Meaning  These findings suggest that ADHD may be associated with excess mortality from injury causes.


    Importance  Few studies have investigated levels of mortality in patients with attention-deficit/hyperactivity disorder (ADHD), and findings have been inconsistent and lacking information on specific causes of deaths.

    Objective  To investigate the association between ADHD and causes of death in Taiwan.

    Design, Setting, and Participants  A nationwide population-based cohort study was conducted using a cross-national Taiwanese registry. The ADHD group comprised 275 980 individuals aged 4 to 44 years with a new diagnosis between January 1, 2000, and December 31, 2012. All individuals with ADHD were compared with 1 931 860 sex- and age-matched controls without ADHD.

    Exposures  The association between ADHD and mortality was analyzed using a Cox regression model that controlled for sex, age, residence, insurance premium, outpatient visits, congenital anomaly, intellectual disability, depression disorder, autism, substance use disorder, conduct disorder, and oppositional defiant disorder. The analysis of suicide, unintentional injury, homicide, and natural-cause mortality was performed by a competing risk adjusted Cox regression controlling for other causes of mortality and potential confounding factors.

    Main Outcomes and Measures  Data on mortality from all causes, suicide, unintentional injury, homicide, and natural causes collected from a national mortality database.

    Results  There were 275 980 individuals with ADHD and 1 931 860 comparison individuals without ADHD in this study. Sex and age at index date were matched. The mean (SD) age was 9.61 (5.74) years for both groups. Most of the participants were male (209 406 in the ADHD group; 1 465 842 in the non-ADHD group; 75.88% for both groups). A total of 4321 participants from both cohorts died during the follow-up period (15.1 million person-years), including 727 (0.26%) from the ADHD group and 3594 (0.19%) from the non-ADHD group. Of those who died, 546 (75.1%) in the ADHD group and 2852 (79.4%) in the non-ADHD group were male. After adjusting for potential confounders, compared with the non-ADHD group, patients with ADHD showed higher overall mortality (adjusted hazard ratio, 1.07; 95% CI, 1.00-1.17) and higher injury-cause mortality from suicide (adjusted hazard ratio, 2.09; 95% CI, 1.62-2.71), unintentional injury (adjusted hazard ratio, 1.30; 95% CI, 1.10-1.52), and homicide (adjusted hazard ratio, 2.00; 95% CI, 1.09-3.68). No increased risk of natural-cause mortality was observed after adjustment.

    Conclusions and Relevance  In this study, ADHD was associated with higher injury-cause mortality, particularly that due to suicide, unintentional injury, and homicide. Although the risk of injury mortality was significantly higher in patients with ADHD than in the non-ADHD group, the absolute risk of mortality was low.