
Mortality in People with ADHD [pdf] - DanBC
http://www.nice.org.uk/Media/Default/newsletter/Eyes-on-Evidence-September-2015.pdf
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unfasten

        All-cause mortality was 5.85 per 10,000 person–years among people 
        with ADHD, compared with 2.21 per 10,000 person–years in people without ADHD. The risk of death 
        among people with ADHD was more than double that in the general population (adjusted mortality rate 
        ratio [MRR]=2.07, 95% confidence interval [CI] 1.70 to 2.50, p<0.0001).
    

They then give the mortality rates for those diagnosed with ADHD another
disorder or substance misuse issues:

    
    
        Age at diagnosis of ADHD was associated with mortality, with the risk of death highest among people 
        diagnosed in adulthood (adjusted MRR=4.25, 95% CI 3.03 to 5.78). Mortality among people with ADHD 
        was also affected by comorbid oppositional defiant disorder or conduct disorder (adjusted MRR=2.17, 
        95% CI 1.33 to 3.31) and by coexisting substance misuse (adjusted MMR=5.63, 95% CI 3.69 to 8.16). 
        Among people without these comorbid conditions, mortality was higher in girls and women with ADHD 
        (adjusted MRR=2.85, 95% CI 1.56 to 4.71) than in boys and men (MRR=1.27, 95% CI 0.89 to 1.76). 
    

The part I found interesting here, that they don't seem to mention elsewhere
in this article, is that the mortality rate for males with ADHD but without
the other disorders is actually lower than their general population numbers
(2.07 general population vs 1.27 for males without one of those issues). They
actually seem to completely ignore it:

    
    
        “Even if these complications did not develop, ADHD was still a risk factor for mortality. This could well be 
        because the core problem of impulsiveness is a cause of accidents, and accidents were the major cause 
        of death.
    

I'm going by the adjusted mortality rate ratio number. If I'm reading this
wrong, please let me know.

~~~
Menge
> (2.07 general population vs 1.27 for males without one of those issues)

Since substance misuse and the other disorders influence mortality rates of
the ADHD population, it is not surprising that they affect mortality in the
general population.

For the inference you seem to be making, I think you would need the mortality
rate of males with no ADHD AND no substance misuse/etc. Based on the data
given, I see no reason to think that is above 1.27.

------
atemerev
After losing my passport three weeks ago for the third time (together with a
brand new MacBook I bought a few days earlier) and dooming myself to months of
documents recovery in two countries I live in, yes, I sometimes just want to f
__* die.

Life with ADHD is hard.

~~~
antihero
Also everyone I know with ADHD, myself included, goes really really fucking
hard at parties and substances. To the point where we put our bodies at
massive risk. I'm working at trying to train out the stupidity but it's hard.

~~~
chris_wot
I don't have that issue and never have. But my impulse control is often poor -
it's pretty freaking awful. Luckily for me it just means I tend to say too
much, although this can have devastating consequences.

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adamrights
Yes, impulsive, creative, wild, dangerous, bored people doing riskier things
have 2x mortality. There's a lot of things that'll increase it a lot more --
like different geolocations.

~~~
lighthawk
I agree that this shouldn't be a surprise. What I'm more interested in is
whether the medication used to treat ADD/ADHD could have an adverse health
effect that would reduce lifespan, i.e. if they ignore accidental deaths
completely, will those on ADD/ADHD meds live just as long as those that do not
take those meds?

~~~
lfowles
For stimulants: increased blood pressure. I've had to switch several times
because I wasn't able to get to an effective dose without sitting firmly in
prehypertension bp levels.

~~~
PhasmaFelis
True, although--if this isn't obvious--this won't necessarily matter if you're
not prone to high blood pressure. I've got several risk factors as well as
ADHD, but even with daily stimulants my blood pressure is comfortably within
the healthy range.

~~~
lfowles
Right, and even then.... I now don't have the impulse to go get soda and snack
food at the convenience store nearby to kill time. I also find it easier to
plan meals and follow through. So, net positive as far as lifespan.

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netcan
I think the vocabulary we use is starting to rub up against its limitations in
problematic ways. Medicine is ver geared towards a pathology-diagnosis-
treatment paradigm.

When it comes to something like blood pressure that's decent enough. Blood
pressure above a certain threshold significantly increases the risks of XYZ
and therefore… There are edge cases and grey areas that come from drawing a
circle around anything that doesn't naturally conform to categorization, but
the paradigm works.

For other things, the paradigm is clunkier. For one thing, doctors have an
ethical (and legal, institutional..) objection to intervention unless some
"pathology" criteria has been met. Since people want to use treatment and/or
sell it, the definition of the pathology is constantly being messed with to
conform.

Consider viagra. According to some, it is a pathology in young men but natural
in older men. In any case, viagra is allowed to be prescribed. But then,
impotence is on a scale. You are not allowed to use the drug unless you fall
within some diagnostic parameters. There is no framework for "elective" use.
You 22 year olds cannot have it. But, it's probably less harm to a robust 22
year old then a 55 year old.

Anyway, ADHD is something that tends to be diagnosed in children when they
exhibit some problematic behavior, usually problematic to schools and
sometimes at home. It sticks as a diagnosis when the treatment works.

So, your sample here is largely kids that had behavioral problems for which
some sort of intervention (ritalin, meditation, diet..) was sought.

It's almost like saying teenagers expelled for drinking at school are more
likely to default on rent in their 40s. It might mean that drinking during
formative years affects your financial responsibility, but it probably means
that teenager who get into trouble often grow into adults who get into
trouble.

~~~
therobot24
I was with you until the last line:

> but it probably means that teenager who get into trouble often grow into
> adults who get into trouble.

I don't need to be the one to disprove it because the loose terminology is
just so ludicrous. You're clumping ADHD in with sooo many other outside
factors that influence what is 'trouble' and it's causes.

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reilly3000
My mother always warned me to maintain focus or I will walk in front of a bus.
Yet she denies to this day I have ADHD (would make her look bad???). After a
lifetime thus far of poor coordination, constantly losing things, awkward
social interaction and rarely finishing projects, I've come to terms with it.
ADHD is associated with risky driving, dangerous misuse of power tools, other
'short cut' behaviors that undermine safety of adhd people and those around
them. It IS a public health issue for that reason yet awareness is low.

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chris_wot
My anxiety levels are off the charts and I sometimes have suicidal thoughts. I
wonder how many ADHD people commit suicide?

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JohnBooty
If nothing else, I hope that studies like this help people to realize that
ADHD is a real thing.

