ADHD and mortality: reading a hazard ratio of 1.7

A meta-analysis published this week in JAMA Network Open brings together the international evidence on mortality in attention deficit hyperactivity disorder (ADHD). Lucy Corrigan, Amber John and colleagues at the University of Liverpool and University College London (UCL) pooled 19 studies covering more than 15.9 million people, mostly large registry cohorts from Europe, Taiwan and North America. Twelve of the studies had data that could be combined in the meta-analyses.

What the paper found

Compared with people without ADHD, people with ADHD had a higher rate of death:

• all causes: hazard ratio (HR) 1.71 (95% confidence interval (CI) 1.31–2.24)
• suicide: HR 1.89 (95% CI 1.21–2.95)
• intentional or unintentional injury: HR 1.55 (95% CI 1.22–2.00)
• natural causes: HR 1.27 (95% CI 1.16–1.38)

Within ADHD, medication use was associated with lower all-cause mortality: HR 0.75 (95% CI 0.64–0.87).

The studies all pointed in the same direction, but the size of the effect varied a great deal between them (I² 98% for all-cause mortality). I² is a measure of how much the results differ between studies. 0% means they agree; values near 100% mean they differ a lot. The pooled figure is an average across very different countries, age groups, health systems and decades. It is not a number to apply to any one child.

What 1.7 means for a family

A hazard ratio compares rates. It tells you how much higher the rate of death is in one group than in another over the period studied. It says nothing on its own about how many people are affected. The 95% CI is the range in which the true figure probably lies.

Death in children and young adults is rare. When the starting rate is small, a relative increase of about 70% still leaves a small absolute risk.

Illustrative example only. These are round numbers chosen to show the arithmetic; they are not figures from this paper. Suppose that over ten years about 2 in every 1,000 young people without ADHD die from any cause. A hazard ratio of 1.7 would put the figure for young people with ADHD at about 3 to 4 in 1,000. In this illustration the difference is one or two extra deaths per 1,000 over ten years.

That is the framing I use when a parent asks. The relative figure explains why services should take this seriously; the absolute figure is the one that matters for a family.

Why the medication finding is an association

The medication result needs the most care. It rests on three studies, all observational, and the authors themselves state that it should not be read as evidence of a causal protective effect.

Three problems apply.

• Confounding by indication. Who is prescribed medication, and who stays on it, is not random. Treated and untreated groups can differ in severity, co-occurring conditions, access to services and family circumstances. Adjustment cannot capture everything.
• Healthy-adherer effect. People who keep taking any long-term medicine tend to differ in other ways too: they attend appointments, have more organised support around them and stay engaged with services. Adherence itself marks out a lower-risk group, whatever the tablet contains.
• Small numbers and variation. The three studies did not agree closely (I² 55%), and three is too few to explore why.

None of this means the association is false. There are plausible routes from treatment to fewer deaths, such as better attention on the road and less impulsive risk-taking. But a hazard ratio of 0.75 from three observational studies is a reason for further research, not a figure to quote to a family as a guaranteed benefit.

Where the extra risk comes from

The higher death rates from suicide and injury concern deaths that are, in principle, preventable, and fit with co-occurring depression, substance use, impulsivity and exclusion from school and work. Many of the children I saw with ADHD were also autistic, and the authors note that some of the excess risk may be due to autism and other neurodevelopmental conditions.

The natural-cause hazard was smaller, at 1.27, but it was the most consistent finding between studies. That fits with higher rates of smoking, cardiovascular and metabolic problems, and poorer access to routine healthcare in adults with ADHD.

Practical points

For clinicians:

• Ask directly about self-harm and suicidal thoughts at reviews, particularly in adolescence and when there is low mood, substance use or exclusion.
• Treat injury risk as part of the ADHD conversation: road safety, cycling, learning to drive, alcohol and drugs.
• Keep people in follow-up. Drop-out, especially at the transition from paediatric to adult services, is often the point at which monitoring stops.
• In adults with ADHD, check physical health: smoking, blood pressure and weight.

For parents and teachers:

• The relative figures describe patterns across very large populations. The absolute risk for an individual child is small.
• If a young person stops medication or drops out of follow-up, tell the GP (general practitioner) or the ADHD team.
• Changes in mood, risk-taking or withdrawal in a child with ADHD deserve prompt attention.

Take-home

ADHD is linked with a higher risk of dying, with the largest relative increases for suicide and injury. Because death in young people is rare, the absolute risk for any one child stays small. The medication finding is encouraging, but it is an association from three observational studies, not proof. The practical message is to keep people in treatment and in follow-up, and to ask about mood, self-harm and safety at every review.

Reference

1. Corrigan L, et al. Mortality among people with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. JAMA Network Open. 2026;9(10):e2639448. Published online 19 October 2026. PMID 42895743. doi:10.1001/jamanetworkopen.2026.39448. https://doi.org/10.1001/jamanetworkopen.2026.39448

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If this article raises difficult feelings for you or someone you care for, support is available. In the UK, call Samaritans free on 116 123, day or night, or text SHOUT to 85258. In England, call NHS 111 and choose option 2 for urgent mental health help. If a life is at risk, call 999.