Benzodiazepines and injury: a risk adjusted model

French, Dustin D.; Campbell, Robert R.; Spehar, Andrea M.; Angaran, David M.

doi:10.1002/pds.967

Cited by 31 publications

(16 citation statements)

References 45 publications

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“…Being married was associated with substantially lower risks of being involved in RTCs compared with being a widow or divorced. This finding is much in line with earlier studies on risk factors for RTCs and injuries conducted on different age segments of the population [5], [7], [12], [32]–[34]. Although the protective effect of being married seems to remain in older male and female drivers, the factors that come into play remain to be determined.…”

Section: Discussionsupporting

confidence: 89%

The Role of Marital Status in the Association between Benzodiazepines, Psychotropics and Injurious Road Traffic Crashes: A Register-Based Nationwide Study of Senior Drivers in Sweden

et al. 2014

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BackgroundAmong senior drivers, benzodiazepines (BZDs) have a documented effect on the risk of road traffic crashes (RTCs). It remains unclear however if BZDs play the same role when considering marital status. Therefore, we aimed to investigate the role of marital status in the association between BZD use and injurious RTCs among senior drivers.MethodsMatched case-control study based on five national Swedish registers (n = 154 225). Cases comprised the first non-alcohol-related injurious RTC sustained by drivers aged 50–80 years from July 2005 to December 2009 and controls included registered residents with a valid license who did not crash during that period. Four controls were matched to each case by sex, age and place of residence. Conditional logistic regression analysis for injurious RTC was performed with adjustment for occupation and number of medications. The main exposure was dispensation of BZDs, alone or in combination with other psychotropic medications, 1–30 days prior to the crash date stratified by marital status.ResultsBZD use, alone or in combination with other psychotropic medications, increased the risk of being involved in an RTC (BZD only: adjusted OR: 1.26, 95% CI: 1.17–1.36; BZDs and other psychotropics: adjusted OR: 1.25, 95% CI: 1.12–1.41). Compared to married drivers, those divorced (1.48, 1.43–1.53) and widowed (1.54; 1.45–1.63) had higher adjusted ORs. Marital status modified the association between BZDs and RTCs, particularly among younger male drivers.ConclusionsBoth BZDs and marital status independently affect the risk for senior drivers to be involved in an RTC. However, marital status plays a role in the association between BZD use and RTCs and this may have implications for targeting risk populations for RTCs among senior drivers.

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Section: Discussionsupporting

confidence: 89%

The Role of Marital Status in the Association between Benzodiazepines, Psychotropics and Injurious Road Traffic Crashes: A Register-Based Nationwide Study of Senior Drivers in Sweden

et al. 2014

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“…[1][2][3][4] Patients aged 65 years and older are particularly susceptible to the side effects of benzodiazepines. 5,6 For instance, the use of benzodiazepines increases the risk of hip fracture in older individuals by at least 50%.…”

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confidence: 99%

A Comparison of Benzodiazepine and Related Drug Use in Nova Scotia and Australia

et al. 2008

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Objective: Benzodiazepines can be a problem if used for long periods, or in at-risk populations, such as the elderly. We compared the use of benzodiazepine and related prescription medicines in Nova Scotia and Australia. Methods: The Nova Scotia Pharmacare Program and the Pharmaceutical Benefits Scheme in Australia were used to obtain dispensing data in comparable populations for all publicly subsidized benzodiazepines and related compounds. Usage was compared from 2000 to 2003, using the World Health Organization anatomical therapeutic chemical and defined daily dosage (DDD) system. We also determined differences in the types of benzodiazepines prescribed. Results: The use of benzodiazepines increased at a steady but comparable rate in both areas. However, the use of benzodiazepines in Nova Scotia was more than double that of Australia in 2000 (123 and 48 DDD/1000 beneficiaries per day, respectively) through 2003 (138 and 57 DDD/1000 beneficiaries per day, respectively). Eight different benzodiazepines made up 90% of the drug use in Nova Scotia by contrast to only 4 different benzodiazepines in Australia. Conclusions: Large differences exist between the type and rate of benzodiazepine prescribing in Nova Scotia and Australia, with Nova Scotia reporting more than twice as much use. Benzodiazepine use in both jurisdictions is increasing. The Canadian findings are especially concerning as benzodiazepine use in the Atlantic provinces has been reported to be less than other provinces. The variations between the 2 jurisdictions may be due to factors such as fewer benzodiazepines available in Australia, differences in prescriber, patient attitudes and behaviours, or different initiatives to influence benzodiazepine use.

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“…The goal of this study was to provide insight into the use of medications that may be associated with these fractures. Polypharmacy and certain specific medications in the elderly have been linked to increased risk of falls and fall‐related injuries, especially fractures [1–22]. In this study, a comparison group was used to determine if there were any important differences in the medication profile between these two outpatient treatment groups.…”

Section: Discussionmentioning

confidence: 99%

National outpatient medication profiling: medications associated with outpatient fractures in community‐dwelling elderly veterans

French

Campbell

Spehar

et al. 2006

Brit J Clinical Pharma

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What is already known about this subject • Polypharmacy, to include a subissue of potentially inappropriate prescribing, in community‐dwelling elderly is widespread. • The objective of this study was to identify the magnitude of problematic outpatient drug prescribing and its potential association as a risk factor for injuries. What this study adds • This is the first national study of outpatient injuries in elderly veterans. • The results are consistent with previous published literature highlighting the risks associated with prescribing central nervous system drugs in the elderly. Aims The primary objective of this retrospective case–control study in an elderly veteran population was to assess the impact of specific medications with recognized side‐effects that increase the risk of a fall and were prescribed prior to fractures treated in the outpatient setting compared with patients treated for nonspecific chest pain. Methods Two national Veterans Health Administration (VHA) databases were used to identify 17 273 unique patients, aged ≥65 years, treated in outpatient settings with a fracture in fiscal year 2005, and for whom we could link to all of their outpatient prescriptions (809 536). For comparison, we identified other elderly patients with outpatient clinic visits for nonspecific chest pain (N = 62 331) for whom we could link with their 2 987 394 outpatient prescriptions. We categorized the fall‐related medications as drugs that primarily affect the cardiovascular (CVS), the central nervous (CNS) or the muscular skeletal system (MSS). Results Significant differences in the two patient groups occurred in the CNS category. Approximately 41% of the patients with fracture‐coded encounters were prescribed CNS drugs compared with 31% of the patients in the comparison group (P < 0.0003). Finally, the use of muscle relaxants in the MSS category was significantly higher in the fracture group than in the nonspecific chest pain group. Conclusions Studies using administrative data can foster the development of more proactive pharmacovigilance systems and assist in formulary refinement, particularly in countries with national healthcare systems that have integrated patient data. Particular attention and monitoring of elderly patients taking CNS medications may be important for injury prevention.

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Benzodiazepines and injury: a risk adjusted model

Cited by 31 publications

References 45 publications

The Role of Marital Status in the Association between Benzodiazepines, Psychotropics and Injurious Road Traffic Crashes: A Register-Based Nationwide Study of Senior Drivers in Sweden

The Role of Marital Status in the Association between Benzodiazepines, Psychotropics and Injurious Road Traffic Crashes: A Register-Based Nationwide Study of Senior Drivers in Sweden

A Comparison of Benzodiazepine and Related Drug Use in Nova Scotia and Australia

National outpatient medication profiling: medications associated with outpatient fractures in community‐dwelling elderly veterans

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