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

Johnell, Kristina; Laflamme, Lucie; Möller, Jette; Monárrez‐Espino, Joel

doi:10.1371/journal.pone.0086742

Cited by 15 publications

(11 citation statements)

References 40 publications

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“…The association between the use of benzodiazepines and z‐hypnotics (zolpidem and zopiclone) and the risk of road traffic crashes has now been documented with consistent results in several epidemiological studies . In France, using a record‐linkage study of national databases, we showed that benzodiazepines and z‐hypnotics accounted for the largest share of the risk attributable to exposure to medicines .…”

Section: Introductionsupporting

confidence: 77%

Road traffic crash risk associated with benzodiazepine and z‐hypnotic use after implementation of a colour‐graded pictogram: a responsibility study

Orriols

Luxcey

Contrand

et al. 2016

Brit J Clinical Pharma

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AIMSTo assess potential change in medicine exposure and association with the risk of road traffic crash across a time period that started before the implementation of a grading system warning of the effect of medicine on driving performance. METHODSData from three French national databases were extracted and matched: the national health care insurance database, police reports and the national police database of injurious crashes. Drivers involved in such crashes in France, from July 2005 to December 2011 and identified by their national identifier, were included. Association with the risk of crash was estimated using a case-control analysis comparing benzodiazepine and z-hypnotic use among drivers responsible or not responsible for the crash. RESULTSTotals of 69 353 responsible and 73 410 non-responsible drivers involved in an injurious crash were included. Exposure to benzodiazepine anxiolytics was associated with an increased risk of being responsible for a road traffic crash during the pre-intervention period (OR = 1.42 [1.24-1.62]). The association disappeared in the post-intervention period, but became significant again thereafter. The risk of being responsible for a crash increased in users of z-hypnotics across the study period. CONCLUSIONSOur results question the efficacy of the measures implemented to promote awareness about the effects of medicines on driving abilities. Prevention policies relating to the general driving population, but also to healthcare professionals, should be reviewed.

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Section: Introductionsupporting

confidence: 77%

Road traffic crash risk associated with benzodiazepine and z‐hypnotic use after implementation of a colour‐graded pictogram: a responsibility study

Orriols

Luxcey

Contrand

et al. 2016

Brit J Clinical Pharma

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“…Prior studies in Brazil, the Netherlands, and Australia have linked benzodiazepine prescriptions-without a dose relationship-to patient selfreporting of poorer health status. [21][22][23] Benzodiazepine prescriptions were similarly linked to higher frequencies of medical diagnoses in two population-based Canadian studies, 40,41 and with a higher score on the Charlson comorbidity index in an Israeli study. 18 Studies linking benzodiazepines to a higher number of medical visits 21 and increased length of hospital stay 26 have been conducted in Israel and Japan, respectively.…”

Section: Discussionmentioning

confidence: 91%

“…6,7,35 Senior patients are particularly vulnerable, because benzodiazepines are associated with falls, [36][37][38][39] hip fractures, 12 delirium, 10,11 disability, 13 dementia, 14,15 and motor vehicle accidents. 40 Osteoporosis has been linked to fractures alongside benzodiazepine prescriptions in The referent for odds ratios for diagnoses and other prescriptions is patients who did not have that diagnosis or prescription patients at risk of falls, although no direct relationship between osteoporosis and benzodiazepine prescriptions has been described. 41,42 Prescribing benzodiazepines disproportionately to patients with COPD, substance use disorders, and osteoporosis, and who are older may contribute to their mortality risk through these mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care

et al. 2016

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BACKGROUND: Benzodiazepine use is associated with adverse drug events and higher mortality. Known risk factors for benzodiazepine-related adverse events include lung disease, substance use, and vulnerability to fracture. OBJECTIVE: To determine whether benzodiazepine prescribing is associated with risk factors for adverse outcomes. DESIGN: Longitudinal cohort study between July 1, 2011, and June 30, 2012. PARTICIPANTS: Patients who visited hospital-and community-based practices in a primary care practicebased research network. MAIN MEASURES:Odds ratio of having a target medical diagnosis for patients who received standard and highdose benzodiazepine prescriptions; rates per 100 patients for outpatient and emergency department visits and hospitalizations. KEY RESULTS: Among 65,912 patients, clinicians prescribed at least one benzodiazepine to 15 % (9821). Of benzodiazepine recipients, 5 % received high doses. Compared to non-recipients, benzodiazepine recipients were more likely to have diagnoses of depression (OR, 2.7; 95 % CI, 2.6-2.9), substance abuse (OR, 2.2; 95 % CI, 1.9-2.5), tobacco use (OR, 1.7; 95 % CI, 1.5-1.8), osteoporosis (OR, 1.6; 95 % CI, 1.5-1.7), chronic obstructive pulmonary disease (OR, 1.6; 95 % CI, 1.5-1.7), alcohol abuse (OR, 1.5; 95 % CI, 1.3-1.7), sleep apnea (OR, 1.5; 95 % CI, 1.3-1.6), and asthma (OR, 1.5; 95 % CI, 1.4-1.5). Compared to low-dose benzodiazepine recipients, high-dose benzodiazepine recipients were even more likely to have certain medical diagnoses: substance abuse (OR, 7.5; 95 % CI, 5.5-10.1), alcohol abuse (OR, 3.2; 95 % CI, 2.2-4.5), tobacco use (OR, 2.7; 95 % CI, 2.1-3.5), and chronic obstructive pulmonary disease (OR, 1.5; 95 % CI, 1.2-1.9).Benzodiazepine recipients had more primary care visits per 100 patients (408 vs. 323), specialist outpatient visits (815 vs. 578), emergency department visits (47 vs. 29), and hospitalizations (26 vs. 15; p < .001 for all comparisons). CONCLUSIONS: Clinicians prescribed benzodiazepines and high-dose benzodiazepines more frequently to patients at higher risk for benzodiazepine-related adverse events. Benzodiazepine prescribing was associated with increased healthcare utilization.

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“…The timing of dosage during the day might also be of importance. Hypnotics and sedatives are taken before bedtime and may therefore exert influence only during sleep, whereas anxiolytics are used during day time and may therefore be more related to adverse outcomes such as day time excessive sedation, injuries, falls, and fractures (Johnell et al ., ).…”

Section: Discussionmentioning

confidence: 99%

Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults

Johnell

Bergman

Fastbom

et al. 2016

Int J Geriat Psychiatry

Self Cite

118

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ObjectiveTo investigate whether psychotropics are associated with an increased risk of fall injuries, hospitalizations, and mortality in a large general population of older adults.MethodsWe performed a nationwide matched (age, sex, and case event day) case–control study between 1 January and 31 December 2011 based on several Swedish registers (n = 1,288,875 persons aged ≥65 years). We used multivariate conditional logistic regression adjusted for education, number of inpatient days, Charlson co‐morbidity index, dementia and number of other drugs.ResultsAntidepressants were the psychotropic most strongly related to fall injuries (ORadjusted: 1.42; 95% CI: 1.38–1.45) and antipsychotics to hospitalizations (ORadjusted: 1.22; 95% CI: 1.19–1.24) and death (ORadjusted: 2.10; 95% CI: 2.02–2.17). Number of psychotropics was associated with increased the risk of fall injuries, (4 psychotropics vs 0: ORadjusted: 1.53; 95% CI: 1.39–1.68), hospitalization (4 psychotropics vs 0: ORadjusted: 1.27; 95% CI: 1.22–1.33) and death (4 psychotropics vs 0: ORadjusted: 2.50; 95% CI: 2.33–2.69) in a dose–response manner. Among persons with dementia (n = 58,984), a dose–response relationship was found between number of psychotropics and mortality risk (4 psychotropics vs 0: ORadjusted: 1.99; 95% CI: 1.76–2.25).ConclusionsOur findings support a cautious prescribing of multiple psychotropic drugs to older patients. © 2016 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons, Ltd.

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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

Cited by 15 publications

References 40 publications

Road traffic crash risk associated with benzodiazepine and z‐hypnotic use after implementation of a colour‐graded pictogram: a responsibility study

Road traffic crash risk associated with benzodiazepine and z‐hypnotic use after implementation of a colour‐graded pictogram: a responsibility study

Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care

Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults

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