Mortality Among People With Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis.

IMPORTANCE

Attention-deficit/hyperactivity disorder (ADHD) is associated with adverse life outcomes and increased mortality. Clarifying the magnitude of mortality risks using international data and the potential association between medication and mortality is essential to inform clinical care and motivate public health strategies to address mortality.

OBJECTIVES

To examine the association between ADHD and all-cause and cause-specific mortality and to assess whether mortality risk differs according to ADHD medication use.

DATA SOURCES: A comprehensive search of PubMed, Web of Science, PsycINFO, EMBASE, MEDLINE, and CINAHL was conducted from database inception to July 8, 2025.

STUDY SELECTION: Eligible studies included quantitative research across all age groups reporting all-cause and/or cause-specific mortality in individuals with ADHD, defined via diagnostic criteria, self-identification, trait measures, or ADHD polygenic risk scores. Exclusion criteria were nonoriginal research, qualitative studies, non-peer-reviewed publications, and studies not reporting mortality outcomes.

DATA EXTRACTION AND SYNTHESIS: Data extraction was conducted independently by 2 reviewers. Study quality was assessed by 1 reviewer. Summary data were extracted from published reports, and pooled hazard ratios (HRs) were calculated using random-effects model meta-analysis.

MAIN OUTCOMES AND MEASURES: The primary outcomes were all-cause mortality and cause-specific mortality (suicide, unintentional or intentional injury, and natural causes), measured using HRs with 95% CIs.

RESULTS

Nineteen studies including 15 920 970 participants (36.1% female) were included. ADHD was associated with increased all-cause mortality (HR, 1.71; 95% CI, 1.31-2.24; P < .001). Significant associations were also observed for suicide (HR, 1.89; 95% CI, 1.21-2.95; P = .005), unintentional or intentional injury (HR, 1.55; 95% CI, 1.22-2.00; P < .001), and natural-cause mortality (HR, 1.27; 95% CI, 1.16-1.38; P < .001). ADHD medication use in people with ADHD was associated with reduced all-cause mortality (HR, 0.75; 95% CI, 0.64-0.87; P < .001). Substantial heterogeneity was observed across studies.

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of ADHD and mortality, ADHD was associated with increased mortality across multiple causes; and ADHD medication was associated with a decreased all-cause mortality risk, underscoring the importance of timely diagnosis and treatment. However, the heterogeneity observed across studies highlights the need for standardized methods and improved control of confounding factors to better characterize mortality risk among individuals with ADHD.