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Methylphenidate and mortality in patients with Attention Deficit Hyperactivity Disorder: a population-based cohort study

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Vincent Chin-Hung Chen, Hsiang-Lin Chan, Shu-I Wu, Mong-Liang Lu, Michael E Dewey, Robert Stewart, Charles Tzu-Chi Lee

Original languageEnglish
JournalBritish Journal of Psychiatry
Publication statusAccepted/In press - 3 Jun 2020

King's Authors

Abstract

Background: Little is known about methylphenidate (MPH) use and mortality outcomes.
Aims: To investigate the association between MPH use and mortality among children with an ADHD diagnosis.
Method: This population-based cohort study analysed the National Health Insurance Research Database (NHIRD) in Taiwan. A total of 68,096 children and adolescents with an Attention Deficit Hyperactivity Disorder (ADHD) diagnosis aged 4 to 17 years with MPH use were compared with 68,096 without MPH prescription, matched on age, gender, and year of first ADHD diagnosis. All participants were followed to death, migration, withdrawal from the National Health Insurance programme, or December 31, 2013. MPH prescriptions were measured on a yearly basis during the study period, and the association between MPH use and mortality was analyzed using a repeated measures time-dependent Cox regression model. The outcome measures included all-cause, unnatural-cause (including suicide, accident and homicide), and natural-cause mortality, obtained from linkage to the National Mortality Register in Taiwan.
Results: The MPH group had lower unadjusted all-cause, natural-, unnatural-, and accident-cause mortality than the comparison group. After controlling for potential confounders, MPH use was associated with a significantly lower all cause-mortality (adjusted hazard ratio [AHR]: 0.81, 95% confidence interval [CI]:0.67~0.98, P=0.027). Delayed use of MPH with higher mortality (AHR: 1.05, 95% CI: 1.01~1.09), and longer MPH use was associated with lower mortality (AHR: 0.83, 95% CI: 0.70~0.98).
Conclusions: MPH use is associated with a reduced overall mortality in children with ADHD in this cohort study, but unmeasured confounding cannot be excluded absolutely.

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