瑞典卡罗琳斯卡研究所Zheng Chang团队研究了ADHD患者接受药物治疗后是否会降低死亡风险。这一研究成果发表在2024年3月12日出版的《美国医学会杂志》上。

注意力缺陷/多动障碍（ADHD）与包括过早死亡在内的不良健康预后风险增加有关，但尚不清楚ADHD药物治疗是否会影响死亡风险。

为了研究ADHD药物治疗的开始是否与降低ADHD患者的死亡率相关，在瑞典一项应用靶向试验模拟框架的全国性观察性队列研究中，研究组确定了2007年至2018年间6岁至64岁被诊断为多动症的患者，并且在诊断前没有服用过多动症药物。随访从多动症诊断开始，直到死亡、移民、多动症诊断后2年或2020年12月31日，以先到者为准。ADHD药物治疗开始定义为在诊断后3个月内配药。研究组评估了多动症诊断后2年内的全因死亡率，以及自然原因（如身体状况）和非自然原因死亡率（如意外伤害、自杀和意外中毒）。

148578名ADHD患者（61356名女性[41.3%]）中84204名（56.7%）开始服用多动症药物。诊断时的中位年龄为17.4岁（IQR，11.6-29.1岁）。初始治疗策略组的2年死亡率风险较低（39.1/10000人），低于非起始治疗策略组（48.1/10?000人），风险差异为-8.9/10?000人（95%CI，−17.3至−0.6）。ADHD药物治疗与全因死亡率（危险比[HR]为0.79；95%CI，0.70-0.88）和非自然原因死亡率（2年死亡率风险，25.9/10?000人与33.3/10000人；风险差异，-7.4/10?000人；95%置信区间，−14.2至−0.5；HR，0.75；95%置信区间，0.66至0.86）相关，但与自然原因死亡率（2年死亡率风险，13.1/10?000人与14.7/10人?000人；风险差异，−1.6/10?000人；95%置信区间，−6.4至3.2；小时0.86；95%CI为0.71～1.05）不相关。

研究结果表明，在被诊断为多动症的个体中，开始服药与显著降低全因死亡率相关，尤其是非自然原因导致的死亡。

附：英文原文

Title: ADHD Pharmacotherapy and Mortality in Individuals With ADHD

Author: Lin Li, Nanbo Zhu, Le Zhang, Ralf Kuja-Halkola, Brian M. D’Onofrio, Isabell Brikell, Paul Lichtenstein, Samuele Cortese, Henrik Larsson, Zheng Chang

Issue&Volume: 2024/03/12

Abstract:

Importance  Attention-deficit/hyperactivity disorder (ADHD) is associated with increased risks of adverse health outcomes including premature death, but it is unclear whether ADHD pharmacotherapy influences the mortality risk.

Objective  To investigate whether initiation of ADHD pharmacotherapy was associated with reduced mortality risk in individuals with ADHD.

Design, Setting, and Participants  In an observational nationwide cohort study in Sweden applying the target trial emulation framework, we identified individuals aged 6 through 64 years with an incident diagnosis of ADHD from 2007 through 2018 and no ADHD medication dispensation prior to diagnosis. Follow-up started from ADHD diagnosis until death, emigration, 2 years after ADHD diagnosis, or December 31, 2020, whichever came first.

Exposures  ADHD medication initiation was defined as dispensing of medication within 3 months of diagnosis.

Main Outcomes and Measures  We assessed all-cause mortality within 2 years of ADHD diagnosis, as well as natural-cause (eg, physical conditions) and unnatural-cause mortality (eg, unintentional injuries, suicide, and accidental poisonings).

Results  Of 148578 individuals with ADHD (61356 females [41.3%]), 84204 (56.7%) initiated ADHD medication. The median age at diagnosis was 17.4 years (IQR, 11.6-29.1 years). The 2-year mortality risk was lower in the initiation treatment strategy group (39.1 per 10000 individuals) than in the noninitiation treatment strategy group (48.1 per 10000 individuals), with a risk difference of 8.9 per 10000 individuals (95% CI, 17.3 to 0.6). ADHD medication initiation was associated with significantly lower rate of all-cause mortality (hazard ratio [HR], 0.79; 95% CI, 0.70 to 0.88) and unnatural-cause mortality (2-year mortality risk, 25.9 per 10000 individuals vs 33.3 per 10000 individuals; risk difference, 7.4 per 10000 individuals; 95% CI, 14.2 to 0.5; HR, 0.75; 95% CI, 0.66 to 0.86), but not natural-cause mortality (2-year mortality risk, 13.1 per 10000 individuals vs 14.7 per 10000 individuals; risk difference, 1.6 per 10000 individuals; 95% CI, 6.4 to 3.2; HR, 0.86; 95% CI, 0.71 to 1.05).

Conclusions and Relevance  Among individuals diagnosed with ADHD, medication initiation was associated with significantly lower all-cause mortality, particularly for death due to unnatural causes.

DOI: 10.1001/jama.2024.0851

Source: https://jamanetwork.com/journals/jama/fullarticle/2816084