People diagnosed with attention-deficit/hyperactivity disorder, or ADHD, face a roughly 71% higher overall risk of early death than people without the condition, according to a review published in JAMA Network Open. The findings point to elevated mortality from both natural and unnatural causes.

The review also identified a potentially protective association involving prescription ADHD medication. Among people with ADHD, those taking prescribed medication had a 25% lower risk of death from any cause compared with those who were not taking medication.

Researchers analyzed findings from 19 observational studies involving nearly 16 million people across three continents. Their goal was to evaluate effects associated with ADHD over extended periods and examine mortality across several categories.

The review considered unnatural causes of death, including suicide and injuries, as well as natural causes linked to physical health conditions. Cardiovascular disease and diabetes were among the natural causes examined.

Across the categories, people with ADHD experienced higher mortality rates than people without the diagnosis. The pattern extended beyond deaths involving suicide or injury and included deaths attributed to natural causes.

“We found that people with ADHD face an increased risk not only of death by suicide and injury, but also of deaths by natural causes, adding to evidence that health inequalities faced by people with ADHD are broad and wide-ranging,” senior author Joshua Stott said in a press release.

Stott is a professor of aging and clinical psychology at University College London. The findings indicate that the mortality disparity associated with ADHD spans several different causes rather than one isolated area of risk.

The risk of death by suicide was nearly twice as high among people with ADHD, representing an 89% increase. The risk of death from intentional or unintentional injuries, including motor vehicle accidents, was 55% higher.

Researchers also found a 27% higher risk of death from natural causes among people with ADHD. The review connected that elevated risk with factors including smoking, substance use and challenges involving executive function.

Those organizational and executive function difficulties can make chronic health conditions harder to manage. They may also create difficulties with attending medical appointments and following treatment plans, according to the source material.

Dr. Elizabeth Landsverk, a geriatric medicine and dementia expert with more than 20 years of experience treating people with Alzheimer’s and cognitive decline, noted that people with ADHD can have greater difficulty with organization. She said that could be one factor contributing to increased cognitive impairment risk.

In one analysis, researchers examined whether medical treatment was associated with differences in overall mortality. The 25% lower risk among medication users suggested that treatment may reduce some behavioral effects and health risks associated with ADHD.

“ADHD is not by definition a life-limiting condition, as the right support and treatment can help people live long and healthy lives,” Stott said. He also emphasized the importance of access to an accurate diagnosis and treatment for people who may have ADHD.

The researchers cautioned that every study included in the review was observational. As a result, the findings demonstrate associations but do not establish that ADHD directly caused the higher mortality or that medication directly produced the lower risk.

The medication findings were drawn from only three of the 19 studies. Researchers therefore described those results as preliminary because they were based on a substantially smaller collection of evidence.

Results also varied considerably among the individual studies. The studies used different diagnostic criteria, health care access conditions and tracking methods, while factors such as socioeconomic status and other mental health conditions were not consistently controlled across the data sets.

“Our findings provide early evidence to suggest that medication may play an important role in supporting the health of people with ADHD, but this is based on a small number of studies and further research is needed to clarify this link,” said first author Lucy Corrigan.

Corrigan is a research assistant in the University of Liverpool’s Department of Psychology. She added, “Medication is just part of the story; many people with ADHD benefit from comprehensive, long-term treatment and support.”

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