本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.0851

摘要内容如下：

重要性

注意力缺陷/多动障碍（ADHD）与包括过早死亡在内的不良健康后果的风险增加有关，但目前尚不清楚ADHD药物治疗是否影响死亡风险。

目的

研究开始ADHD药物治疗是否与降低ADHD患者的死亡风险相关。

设计、设置和参与者

在瑞典进行的一项应用TARGET试验仿真框架的全国观察性队列研究中，我们确定了6岁至64岁的个体，这些个体在2007年至2018年期间被诊断为ADHD，并且在诊断前没有ADHD药物分配。随访从ADHD诊断开始，直至死亡、移民、ADHD诊断后2年或2020年12月31日，以先到者为准。

曝光

ADHD药物治疗开始定义为在诊断后3个月内配药。

主要成果和措施

我们评估了ADHD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）。

结果

在148578名ADHD患者（61356名女性[41.3%]）中，有84204名（56.7%）开始接受ADHD药物治疗。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年死亡风险（39.1/10000人）低于非初始治疗策略组（48.1/10000人），风险差异为-8.9/10000人（95%CI，-17.3至-0.6）。开始ADHD药物治疗与全因死亡率显著降低相关（风险比[HR]，0.79；95%CI，0.70-0.88）和非自然原因死亡率（2年死亡风险，25.9/10000人vs 33.3/10000人；风险差，-7.4/10000人；95%置信区间，-14.2至-0.5；心率0.75；95%CI，0.66至0.86），但不包括自然原因死亡率（2年死亡风险，13.1/10000人vs 14.7/10000人；风险差，-1.6/10000人；95%可信区间为-6.4~3.2；心率为0.86；95%置信区间，0.71至1.05）。

结论和相关性

在诊断为ADHD的个体中，开始药物治疗与全因死亡率显著降低相关，尤其是非自然原因导致的死亡。

英文原文如下：

Abstracts

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 148 578 individuals with ADHD (61 356 females [41.3%]), 84 204 (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 10 000 individuals) than in the noninitiation treatment strategy group (48.1 per 10 000 individuals), with a risk difference of -8.9 per 10 000 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 10 000 individuals vs 33.3 per 10 000 individuals; risk difference, -7.4 per 10 000 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 10 000 individuals vs 14.7 per 10 000 individuals; risk difference, -1.6 per 10 000 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.

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