Adults in the United Kingdom diagnosed with attention-deficit/hyperactivity disorder had shorter life expectancy than matched controls without the condition, according to a matched cohort study of more than 330,000 individuals.

Males with attention-deficit/hyperactivity disorder (ADHD) lost an estimated 6.78 years of life, and females lost 8.64 years, compared with counterparts without a diagnosis.

The retrospective analysis, published in The British Journal of Psychiatry, used UK primary care data from 2000 to 2019. Researchers analyzed electronic health records from 794 practices contributing to the IQVIA Medical Research Data. The study identified 30,039 adults with ADHD, matched by age, sex, and practice to 300,390 controls. Across the study period, approximately 0.32% of the adult sample had an ADHD diagnosis—roughly 1 in 9 of the estimated 2.8% true prevalence of adult ADHD based on population survey data.

Mortality was higher among individuals with ADHD. Among males, 0.83% with ADHD died during follow-up, compared with 0.52% of matched controls. Among females, 2.22% with ADHD died, compared with 1.35% of controls. The mortality rate ratio was 1.89 for males and 2.13 for females.

Apparent life expectancy at age 18 years was 73.26 years for males with ADHD, compared with 80.03 years in controls. For females, life expectancy was 75.15 years in the ADHD group versus 83.79 years in controls.

Adults with ADHD had higher baseline rates of physical and mental health conditions than matched peers. Epilepsy was diagnosed in 3.38% of males with ADHD compared with 1.14% of controls, and in 3.83% of females compared with 1.13% of controls.

Cardiometabolic and respiratory conditions were also more common in the ADHD cohort. Among males with ADHD, 1.51% had hypertension and 2.49% had chronic respiratory disease.

Psychiatric comorbidities were elevated across groups. Depression was diagnosed in 14.56% of males and 31.22% of females with ADHD; anxiety in 11.24% of males and 21.93% of females.

Lifestyle risk factors were more prevalent among adults with ADHD. Smoking was reported in 40.20% of males, and potentially harmful alcohol use in 7.34%.

Mortality rates rose with age across all groups. Among males aged 65 years and older, the mortality rate was 4793.19 per 100,000 person-years in the ADHD group compared with 3805.61 in controls. Among females in this age group, the rate was 6834.67 versus 3975.05.

Socioeconomic deprivation was reported using Townsend quintiles, although some data were missing. Ethnicity data were not included in the analysis because of non-random missingness in the dataset.

Sensitivity analyses including possible unregistered deaths did not meaningfully alter the findings.

“There is a potential for new initiatives, such as improved service pathways and awareness of health needs among people with ADHD to reduce the risk of premature mortality. Alternatively, widening societal inequalities may exacerbate challenges for people with ADHD who are disproportionately likely to experience adversity,” said Elizabeth O’Nions, PhD, of the UCL Research Department of Clinical, Educational and Health Psychology in London.

The authors noted that findings were limited to individuals with a recorded diagnosis of ADHD and may not be generalizable to those without a formal diagnosis.

Full disclosures are available in the original publication.