The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort

Obiora, Eneanya; Hubbard, Richard; Sanders, Robert D.; Myles, Puja R.

doi:10.1136/thoraxjnl-2012-202374

Cited by 144 publications

(160 citation statements)

References 30 publications

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“…(2) Consistency is the strongest evidence, with 33 of 34 studies showing a positive association of hypnotic consumption and mortality. (3) Several kinds of specificity of hypnotics-mortality associations have been identified: the excess of deaths at night among hypnotics users [21], the excesses of infection [13], COPD [57], and suicide deaths [50], and the excess of specific cancers such as lung and esophagus [38]. (4) The temporality of hypnotic usage preceding death is consistent with causation.…”

Section: Bradford Hill Criteria Of Causation Are Fulfilledmentioning

confidence: 99%

“…Obiora et al examined pneumonia mortality in 4964 cases and 29,697 controls also selected from the UK primary care patient database [13]. Using the Charlson's comorbidity index to adjust for comorbidities, as compared with controls, fully adjusted long-term mortality hazard ratios were 1.42 (95 % CI 1.21-1.67) for current benzodiazepine use, 1.49 (95 % CI 1.19-1.85) for recent benzodiazepine use, and 1.24 (95 % CI 1.09-1.41) for past benzodiazepine use.…”

Section: No Formal Meta-analysismentioning

confidence: 99%

“…Also, controlled trials prove that many hypnotics impair next-day driving performance. Moreover, hypnotics are epidemiologically associated with an increased rate of driver-at-fault vehicle crashes as well as falls and serious infections [13,[27][28][29][30][31][32][33][34][35][36]. Other studies show that hypnotic use is associated with new cancer incidence [37][38][39].…”

Section: Over-adjustment Of Confoundersmentioning

confidence: 99%

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Mortality Risk of Hypnotics: Strengths and Limits of Evidence

Kripke

2015

Drug Saf

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Sleeping pills, more formally defined as hypnotics, are sedatives used to induce and maintain sleep. In a review of publications for the past 30 years, descriptive epidemiologic studies were identified that examined the mortality risk of hypnotics and related sedative-anxiolytics. Of the 34 studies estimating risk ratios, odds ratios, or hazard ratios, excess mortality associated with hypnotics was significant (p \ 0.05) in 24 studies including all 14 of the largest, contrasted with no studies at all suggesting that hypnotics ever prolong life. The studies had many limitations: possibly tending to overestimate risk, such as possible confounding by indication with other risk factors; confusing hypnotics with drugs having other indications; possible genetic confounders; and too much heterogeneity of studies for meta-analyses. There were balancing limitations possibly tending towards underestimates of risk such as limited power, excessive follow-up intervals with possible follow-up mixing of participants taking hypnotics with controls, missing dosage data for most studies, and over-adjustment of confounders. Epidemiologic association in itself is not adequate proof of causality, but there is proof that hypnotics cause death in overdoses; there is thorough understanding of how hypnotics euthanize animals and execute humans; and there is proof that hypnotics cause potentially lethal morbidities such as depression, infection, poor driving, suppressed respiration, and possibly cancer. Combining these proofs with consistent evidence of association, the great weight of evidence is that hypnotics cause huge risks of decreasing a patient's duration of survival. Key PointsMost sleeping pills e.g., benzodiazepines and ''Z'' benzodiazepine agonists (like eszopiclone) are associated with early death, and they most probably cause serious increases in mortality.Benzodiazepine agonist sleeping pills and diphenhydramine should not be prescribed for insomnia, except in long-term controlled trials and hospice care.

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Section: Bradford Hill Criteria Of Causation Are Fulfilledmentioning

confidence: 99%

Section: No Formal Meta-analysismentioning

confidence: 99%

Section: Over-adjustment Of Confoundersmentioning

confidence: 99%

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Mortality Risk of Hypnotics: Strengths and Limits of Evidence

Kripke

2015

Drug Saf

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“…16 In our study, benzodiazepine use was associated with a 30% increased risk of pneumonia. Another smaller case-control study found no association between benzodiazepine use and pneumonia among older adults, which may have been related to the small sample size for this study.…”

Section: Discussionmentioning

confidence: 79%

“…15 A nested case-control study in the United Kingdom evaluated benzodiazepine use and occurrence of pneumonia in people of all ages and found a 50% increased risk of pneumonia. 16 However, another case-control study in the United States among older adults did not find an association between benzodiazepine use and pneumonia but reported an increased risk for opioid use. 17 A recent population-based cohort study on benzodiazepine use found that it also was associated with adverse respiratory outcomes among older adults with chronic obstructive pulmonary disease (COPD).…”

Section: Methodsmentioning

confidence: 99%

Risk of pneumonia associated with incident benzodiazepine use among community-dwelling adults with Alzheimer disease

Taipale

Tolppanen

Koponen

et al. 2017

CMAJ

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Association Between Mood Disorders and Risk of COVID-19 Infection, Hospitalization, and Death

et al. 2021

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Preexisting noncommunicable diseases (eg, diabetes) increase the risk of COVID-19 infection, hospitalization, and death. Mood disorders are associated with impaired immune function and social determinants that increase the risk of COVID-19. Determining whether preexisting mood disorders represent a risk of COVID-19 would inform public health priorities.OBJECTIVE To assess whether preexisting mood disorders are associated with a higher risk of COVID-19 susceptibility, hospitalization, severe complications, and death.DATA SOURCES Systematic searches were conducted for studies reporting data on COVID-19 outcomes in populations with and without mood disorders on PubMed/MEDLINE,

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The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort

Cited by 144 publications

References 30 publications

Mortality Risk of Hypnotics: Strengths and Limits of Evidence

Mortality Risk of Hypnotics: Strengths and Limits of Evidence

Risk of pneumonia associated with incident benzodiazepine use among community-dwelling adults with Alzheimer disease

Association Between Mood Disorders and Risk of COVID-19 Infection, Hospitalization, and Death

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