Parental Cardiometabolic History, Family Income, and Cardiometabolic Risk in Antipsychotic-Treated Children, Adolescents, and Young Adults: A Nationwide Cohort Study.

BACKGROUND

Children and adolescents treated with antipsychotics are at increased risk of cardiometabolic adverse events (CMAEs). It is unclear how far this risk is shaped by parental CMAE history or socioeconomic status.

OBJECTIVES

We examined whether parental CMAE history and family income modify the cardiometabolic risk associated with antipsychotic use in children, adolescents, and young adults.

METHODS

We conducted a nationwide cohort study of Danish children and adolescents (aged 6-17 years) and young adults (aged 18-31 years) with psychiatric diagnoses treated with antipsychotics in 2000-2021. Each exposed individual was age/sex-matched to up to 10 controls. The outcome was any CMAE, identified through hospital contacts or related prescriptions. Using propensity score weighting, we estimated weighted incidence rates (wIR) and incidence rate ratios (wIRR) with 95% confidence intervals (CIs), stratified by parental CMAE history and family income.

RESULTS

The cohort comprised 8488 children/adolescents and 27,326 young adults treated with antipsychotics, and 293,678 unexposed controls. Among children/adolescents, CMAE incidence increased with the number of parents with CMAE (wIRno parents = 10.7/1000 person-years [PY]; wIRone parent = 14.0/1000 PY; wIRboth parents = 17.7/1000 PY). A similar gradient was observed in young adults (17.8-27.4/1000 PY). Antipsychotic-related CMAE risk was generally higher in children/adolescents (wIRR = 1.51-2.11) than in young adults (wIRR = 1.46-1.55). Higher family income was associated with lower CMAE risk in both groups (children/adolescents: odds ratio [OR] 0.92; 95% CI 0.89-0.95; young adults: OR 0.97; 95% CI 0.95-0.99).

CONCLUSIONS

Absolute CMAE risk rose with each affected parent, whereas the antipsychotic-related relative risk was largest in offspring with no affected parent. Higher family income was associated with lower risk in both age groups. Both family history of CMAEs and socioeconomic context should inform antipsychotic prescribing as well as cardiometabolic monitoring and preventive strategies, particularly in children and adolescents.