Supplementary file 1_Association of lithium versus valproate initiation with all-cause mortality and incident dementia: a multinational real-world cohort study.docx

A 30-day prescription-confirmed analysis and lag-time analyses were performed as supportive and sensitivity analyses, respectively.</p>Results<p>During follow-up, 884 deaths occurred among lithium initiators and 1,585 among valproate initiators. The corresponding five-year Kaplan–Meier-estimated cumulative event probabilities for all-cause mortality were 6.61 and 10.65%, respectively. Lithium initiation was associated with a lower recorded risk of all-cause mortality than valproate initiation [hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.53–0.63; p < 0.001].

Incident dementia occurred in 495 lithium initiators and 754 valproate initiators, with corresponding five-year Kaplan–Meier-estimated cumulative event probabilities of 3.51 and 4.85%, respectively. Lithium initiation was also associated with a lower recorded risk of incident dementia (HR 0.68, 95% CI 0.60–0.76; p < 0.001). Findings remained directionally consistent in the supportive prescription-confirmed and lag-time analyses.</p>Conclusion<p>Lithium initiation was associated with lower recorded risks of all-cause mortality and incident dementia than valproate initiation.

These associations remained directionally consistent across supportive and sensitivity analyses, although residual confounding inherent to observational studies cannot be excluded.</p>