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Meta-Analysis
. 2022 Apr 1;176(4):e216401.
doi: 10.1001/jamapediatrics.2021.6401. Epub 2022 Apr 4.

Mortality in Persons With Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis

Ferrán Catalá-López  1   2   3 , Brian Hutton  1   4 , Matthew J Page  5 , Jane A Driver  6   7   8 , Manuel Ridao  9 , Adolfo Alonso-Arroyo  10   11 , Alfonso Valencia  12 , Diego Macías Saint-Gerons  2 , Rafael Tabarés-Seisdedos  2
Affiliations
Meta-Analysis

Mortality in Persons With Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis

Ferrán Catalá-López et al. JAMA Pediatr. .

Abstract

Importance: Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are childhood-onset disorders that may persist into adulthood. Several studies have suggested that they may be associated with an increased risk of mortality; however, the results are inconsistent.

Objective: To assess the risk of mortality among persons with ASD or ADHD and their first-degree relatives.

Data sources: A search of MEDLINE, Embase, Scopus, Web of Science, and PsycINFO (published from inception to April 1, 2021) was supplemented by searching reference lists of the retrieved articles.

Study selection: Cohort and case-control studies that reported mortality rate ratios (RRs) in persons with ASD or ADHD and/or their first-degree relatives compared with the general population or those without ASD/ADHD were included.

Data extraction and synthesis: Screening, data extraction, and quality assessment were performed by at least 2 researchers independently. A random-effects model was used to meta-analyze individual studies and assessed heterogeneity (I2).

Main outcomes and measures: All-cause mortality in association with ASD or ADHD. Secondary outcome was cause-specific mortality.

Results: Twenty-seven studies were included, with a total of 642 260 individuals. All-cause mortality was found to be higher for persons with ASD (154 238 participants; 12 studies; RR, 2.37; 95% CI, 1.97-2.85; I2, 89%; moderate confidence) and persons with ADHD (396 488 participants; 8 studies; RR, 2.13; 95% CI, 1.13-4.02; I2, 98%; low confidence) than for the general population. Among persons with ASD, deaths from natural causes (4 studies; RR, 3.80; 95% CI, 2.06-7.01; I2, 96%; low confidence) and deaths from unnatural causes were increased (6 studies; RR, 2.50; 95% CI, 1.49-4.18; I2, 95%; low confidence). Among persons with ADHD, deaths from natural causes were not significantly increased (4 studies; RR, 1.62; 95% CI, 0.89-2.96; I2, 88%; low confidence), but deaths from unnatural causes were higher than expected (10 studies; RR, 2.81; 95% CI, 1.73-4.55; I2, 92%; low confidence).

Conclusions and relevance: This systematic review and meta-analysis found that ASD and ADHD are associated with a significantly increased risk of mortality. Understanding the mechanisms of these associations may lead to targeted strategies to prevent avoidable deaths in high-risk groups. The substantial heterogeneity between studies should be explored further.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Valencia reported grants from the Spanish Ministry of Science and Technology during the conduct of the study and grants from Spanish Ministry of Science, Spanish Ministry of Economy, European Commission Framework Program, IBM Research, Generalitat de Catalunya, and EuroHPC outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram of Study Selection
Figure 2.
Figure 2.. Risk of All-Cause Mortality in People With Autism Spectrum Disorder (ASD)
The size of each box indicates the effect of each study by weight assigned using the random-effects (RE) model; diamond, estimated effect size; and width of diamond, the precision of the estimate (95% CI). RR indicates risk ratio.
Figure 3.
Figure 3.. Risk of All-Cause Mortality in People With Attention-Deficit/Hyperactivity Disorder (ADHD)
The size of each box indicates the effect of each study by weight assigned using the random-effects (RE) model; diamond, estimated effect size; and width of diamond, the precision of the estimate (95% CI). RR indicates risk ratio.
See this image and copyright information in PMC

Comment in

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