American Statistical Association New York City Metropolitan Area Chapter New York State Psychiatric Institute at Columbia University Medical Center Biostatistics Seminar

The authors sought to determine whether a significant association exists between the use of stimulants and the rare event of sudden-unexplained death in children and adolescents.

Methods: A matched case-control design was performed. State vital statistics mortality data from 1985-1996 were used to identify 564 cases of sudden death at ages 7 through 19 years, occurring across the United States, and a matched group of 564 young people who died as passengers in motor vehicle traffic accidents. The primary exposure measure was the presence of amphetamine, dextroamphetamine, methamphetamine, or methylphenidate, based on informant reports or as noted in medical examiner records, toxicology results, or death certificates.

Results: Ten (1.8%) of the sudden-unexplained-death cases were determined to have been taking stimulants, specifically methylphenidate; in contrast, use of stimulants was found in only two subjects in the comparison group (0.4%), only one involving methylphenidate use. A significant association of stimulant use with sudden-unexplained death emerged from the primary analysis based on exact conditional logistic regression (odds ratio=7.4; 95% confidence interval=1.4 to 74.9). A comprehensive series of sensitivity analyses yielded qualitatively similar findings.

Conclusions: This case-control study provides support for an association between the use of stimulants and sudden-unexplained death among children and adolescents. Although sudden unexplained death is a rare event, this finding should be considered in the context of other data about the risk and benefit of stimulants in medical treatment.