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Background/Objectives Prescription sleep medication use is most prevalent among women and older adults. Morning drowsiness and impaired coordination are side-effects of sleep medications that may affect driving safety. The association between current use of zolpidem-containing medications and motor vehicle collisions (MVCs) was evaluated among very old drivers. Patients/Methods Participants were current drivers aged ≥70 years residing in north-central Alabama, spoke English, had a valid driver's license, and drove within the past 3 months (n=2,000). Current zolpidem use was determined by pill-bottle review. Participant's 5-year MVC history was determined from Alabama Department of Public Safety accident reports. The 5-year MVC and at-fault MVC rate ratios (RR) were estimated comparing zolpidem users with nonusers in the overall sample and a-priori defined age and sex subgroups. Results The unadjusted RR (95%CI) of MVCs comparing zolpidem users with nonusers was attenuated after adjustment (1.46 [1.02-2.08] and 1.38 [0.97-1.98], respectively). Among women, the unadjusted and adjusted RRs (95%CI) were 1.65 (1.03-2.66) and 1.61 (1.00-2.60), respectively. The unadjusted and adjusted RRs (95%CI) among those aged ≥80 years were 2.24 (1.19-4.57) and 2.35 (1.20-4.61), respectively. There were no statistically significant associations among men or participants <80 years old. Similar patterns were present for at-fault MVCs. Conclusion Current zolpidem users, specifically women and individuals aged ≥80 years, had higher MVC rates than nonusers. Practitioners should consider behavioral treatment before initiating low doses of zolpidem and escalating it as needed to achieve restorative sleep in females and individuals aged ≥80 years to reduce the risk of zolpidem-associated MVCs.

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Purpose Medical bankruptcies occur when an individual experiences an acute or chronic health event, and the costs of care exceed the individual’s ability to pay. In such cases, the individual typically files for bankruptcy. There is an extensive literature that estimates the prevalence of medical bankruptcy, but studies either select a population whose medical care is extremely expensive or chooses ad hoc thresholds for medical bankruptcy categorizations. In both cases, the prevalence of medical bankruptcy is biased. The purpose of this paper is to estimate the actual prevalence of medical bankruptcies in a manner that avoids these limitations. Design/methodology/approach Data are randomly drawn from a single US Bankruptcy Court district. Following the literature, an ad hoc threshold of medical debts which places the bankruptcy filer “at risk” for a medical bankruptcy is postulated. Misclassification analyses are used to estimate the likelihood of a medical bankruptcy filing while adjusting for the use of ad hoc thresholds. Findings The naive prevalence of medical bankruptcy is 23.1 percent, but exceeds 50 percent when accounting for misclassification. Many individuals are “ostensibly” medically bankrupt. They are already seriously indebted, and any outside financial shock, including but not limited to medical bills, can push these debtors into insolvency. Originality/value Bankruptcy is an important social safety net. An improved understanding of the types and magnitudes of medical debts which precipitate a bankruptcy filing can lead to policies that improve outcomes for bankruptcy filers and reduce the social costs of bankruptcy.

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