Life Expectancy Shorter in Patients With ADHD

Life expectancy was shorter than it should be in adult patients living with attention-deficit/hyperactivity disorder (ADHD), according to a study published in The British Journal of Psychiatry.¹ Unmet treatment needs and modifiable risk factors are the likely causes of this discrepancy in life expectancy.

Patients with at least 6 months of a pattern of inattention or hyperactivity-impulsivity can be diagnosed with ADHD.² As many as 90% of children with ADHD will live with the condition through adulthood. Inequality and adversity are more likely in patients living with ADHD, including educational and financial adversity. This study aimed to use mortality data to estimate the average years of life lost in adults from the United Kingdom between 2000 and 2019.

IQVIA Medical Research Data (IMRD) was the source of the primary care health records for this study. The National Health Service also contains data from most residents of the UK. Individuals were included if they had a diagnostic code for ADHD recorded at any time. The entry date for the cohort could be different for the participants, with dates of diagnosis, registration at the practice, their practice using IMRD, their primary care doctor meeting quality criteria that allowed for electronic health records, and January 1, 2000, all used as starting points, whichever came earliest. Date of exit could be any of January 16, 2019; date of death; date of deregistration; or date of their practice no longer using IMRD.

Individuals living with ADHD had a shorter estimated life expectancy compared with those who did not have ADHD. | Image credit: ClareM - stock.adobe.com

The primary outcome of the study was all-cause death. Data on diabetes, socioeconomic deprivation, hypertension, ischemic heart disease, epilepsy, depression, anxiety, chronic respiratory disease, intellectual disabilities, personality disorders, and habits regarding smoking and alcohol use were collected about the participants.

There were 30,039 people with ADHD and 300,390 controls who were included in the study. The median (IQR) year of diagnosis was 2003 (1999-2008) overall, and the median age at entry was 18.95 (18.00-24.54) years for men and 22.10 (18.00-31.50) years for women.

A total of 0.83% of the men diagnosed with ADHD died compared with 0.52% of the men who did not have ADHD. Women with ADHD also had a higher percentage of those who died, at 2.22% compared with 1.35% of the controls. Men with ADHD were 1.89 (95% CI, 1.62-2.19) times more likely to die during follow up compared with a control, whereas women with ADHD were 2.13 (95% CI; 1.79-2.53) times more likely to die compared with controls.

Life expectancy for men with ADHD was estimated at 73.26 (95% CI, 71.06-75.41) years compared with 80.03 (95% CI, 79.34-80.74) years in controls. Women with ADHD also had a lower life expectancy of 75.15 (95% CI; 72.99-77.11) years compared with the controls who had a life expectancy of 83.79 (95% CI, 83.12-84.44) years. The loss of life estimates were 6.78 (95% CI, 4.50-9.11) years in men and 8.64 (95% CI, 6.55-10.91) years in women.

There were some limitations to this study. The cause of death was not available in any of the data, which disallowed drawing conclusions about the years of life lost, and the diagnosed adults could overrepresent the people in the UK who have mental health and/or a neurodevelopmental condition due to a lack of specialist services for patients with ADHD. Generalizability could also be limited due to the population of the study being entirely from the UK. Socioeconomic status was not adjusted for and race/ethnicity was not considered.

The researchers concluded that patients with ADHD are living shorter lives likely due to modifiable factors that could include smoking and unmet treatment needs. Unmet support needs and treatment needs need to be addressed through legislation to “include approaches to improve awareness of physical and mental health conditions that are more common in people with ADHD, and promotion of timely access to mental health support and smoking cessation services.”

References

1. O’Nions E, El Baou C, John A, et al. Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study. Br J Psychiatry. Published online January 23, 2025. doi:10.1192/bjp.2024.199

2. Attention-deficit/hyperactivity disorder (ADHD). National Institute of Mental Health. Updated January 2025. Accessed January 23, 2025. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd