Use of anxiolytic or hypnotic drugs and total mortality in a general middle‐aged population

Hausken, Anne Margrethe; Skurtveit, Svetlana; Tverdal, Aage

doi:10.1002/pds.1417

Cited by 47 publications

(54 citation statements)

References 83 publications

(132 reference statements)

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“…Previous studies have been inconsistent, with some studies observing significant relationships between hypnotic prescriptions and mortality [16,[20][21][22][23][24][25]37] and others not [16][17][18][19]. Our findings suggest that these differences are probably largely due to failure to take into account confounding associations, notably common affective symptoms and sleep complaints, although other factors such as study design, participant age, and class of hypnotics probably also influence study outcome.…”

Section: Discussioncontrasting

confidence: 48%

“…Four observational studies in young adults [16,17] and elderly people [18,19] found no significant associations between hypnotics and all-cause mortality. Other studies reported a significant association with excessive all-cause deaths in adults [20][21][22]. Two large studies with very wide age ranges from young adult to older elderly people [23][24][25] found significant associations in all age groups, including the elderly.…”

Section: Introductionmentioning

confidence: 95%

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Hypnotics and mortality in an elderly general population: A 12-year prospective study

et al. 2013

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Background: Hypnotics are widely used by the elderly, and their impact on mortality remains controversial. The inconsistent findings could be due to methodological limitations, notably the lack of control for underlying sleep symptoms or illness associated with hypnotic use, for example, insomnia symptoms and excessive daytime sleepiness, depression and anxiety. Our objective was to examine the association between the use of hypnotics and mortality risk in a large cohort of community-dwelling elderly, taking into account a wide range of potential competing risks including sociodemographic characteristics, lifestyle, and chronic disorders as well as underlying psychiatric disorders and sleep complaints. Methods: Analyses were carried out on 6,696 participants aged 65 years or older randomly recruited from three French cities and free of dementia at baseline. Adjusted Cox proportional hazards models with delayed entry, and age of the participants as the time scale, were used to determine the association between hypnotic use and 12-year survival. Results: At baseline, 21.7% of the participants regularly used at least one hypnotic. During follow-up, 1,307 persons died, 480 from cancer and 344 from cardiovascular disease. Analyses adjusted for study center, age and gender showed a significantly greater risk of all-cause and cardiovascular-related mortality with hypnotics, particularly benzodiazepines, and this increased with the number of hypnotics used. None of these associations were significant in models adjusting for sociodemographic and lifestyle characteristics, chronic disorders including cardiovascular pathologies, sleep and psychiatric disorders. Results remained unchanged when duration of past hypnotic intake or persistent versus intermittent use during follow-up were taken into account. Conclusions: When controlling for a large range of potential confounders, the risk of mortality was not significantly associated with hypnotic use regardless of the type and duration. Underlying psychiatric disorders appear to be the principal confounders of the observed association.

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Section: Discussioncontrasting

confidence: 48%

Section: Introductionmentioning

confidence: 95%

Hypnotics and mortality in an elderly general population: A 12-year prospective study

et al. 2013

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“…Several reports carefully examined insomnia and depression as potential confounders of the association of hypnotics with mortality, finding that insomnia and depression could explain little if any of this association 19,[22][23][24] . Note also that the evidence does not permit us to assume that causality between insomnia, depression, and hypnotic usage is a one-way path when contemplating confounder control, as there is reverse causality 25,26 .…”

Section: Results Had Many Similarities To Those Of Weich Et Almentioning

confidence: 99%

“…In combined clinical trials, participants randomized to hypnotics suffered 2.1 times as many incident (new) depressions as those randomized to placebo (P<0.002) 25 . These were not exacerbations of pre-existing depressions.…”

Section: Hypnotics Increase Incidence Of Clinical Depressionmentioning

confidence: 99%

Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Kripke

2017

F1000Res

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This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. Short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics have usually been prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders offer safer and more effective alternative approaches to insomnia.

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“…All men (15 606) and women (14 748) aged 40-42 in the two Norwegian counties of Østfold and Aust-Agder were invited to participate in a population-based health survey organised by the National Health Screening Service, and has been described earlier [12][13][14] . The health survey was directed toward cardiovascular disease.…”

Section: Health Surveys-information On Independent Variablesmentioning

confidence: 99%

Disability pension is associated with the use of benzodiazepines 20 years later: A prospective study

Hartz

Lundesgaard

Tverdal

2009

Scand J Public Health

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ObjectivesThe Norwegian Government urges that actions are needed to stimulate the working capacity in disability pension (DP) recipients with such a potential. Identification of factors that may impair rehabilitation efforts, such as information on the start of benzodiazepines in DP recipients, may be useful information in this context. Thus, the aim of the study was to describe the association between receipt of disability pension and later prescriptions of benzodiazepines among non-users at baseline. MethodsWe followed a cohort reporting non-use of benzodiazepines, 6645 men and 6455 ResultsIn both gender, the proportion started on at least one prescription of a benzodiazepine was about doubled among those reporting to be on a DP 20 years in the past, 21 % of all men and 29 % of all women, respectively.Univariate odds ratio for a benzodiazepine prescription for men and women on a DP were 2.6 (95% CI 1.5-4.4) and 2.1 (1.5-2.9), respectively, as compared with those not receiving a DP. After adjustment for alcohol, smoking habits, physical activity, socioeconomic and health variables, the odds ratios was lowered for both sexes, being 2.1 (1.2-3.7) (men) and 1.6 (1.1-2.3) (women). Conclusions 4For both men and women the chance of being prescribed benzodiazepines was higher among those reporting to DP recipients 20 years in the past.

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Use of anxiolytic or hypnotic drugs and total mortality in a general middle‐aged population

Cited by 47 publications

References 83 publications

Hypnotics and mortality in an elderly general population: A 12-year prospective study

Hypnotics and mortality in an elderly general population: A 12-year prospective study

Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Disability pension is associated with the use of benzodiazepines 20 years later: A prospective study

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