Title: | Association between prescription of hypnotics/anxiolytics and mortality in multimorbid and non-multimorbid patients: a longitudinal cohort study in primary care |
Author: |
|
Date: | 2019-12-05 |
Language: | English |
Scope: | e033545 |
University/Institute: | Háskóli Íslands University of Iceland |
School: | School of Health Sciences (UI) Heilbrigðisvísindasvið (HÍ) |
Department: | Læknadeild (HÍ) Faculty of Medicine (UI) Faculty of Pharmaceutical Sciences (UI) Lyfjafræðideild (HÍ) |
Series: | BMJ Open;9(12) |
ISSN: | 2044-6055 |
DOI: | 10.1136/bmjopen-2019-033545 |
Subject: | Anxiolytics; Hypnotics; Mortality; Multimorbidity; Primary care; Heimilislækningar; Svefnlyf; Róandi lyf; Langvinnir sjúkdómar; Dánartíðni |
URI: | https://hdl.handle.net/20.500.11815/1511 |
Citation:Linnet K, Sigurdsson JA, Tomasdottir MO, et al. Association between prescription of hypnotics/anxiolytics and mortality in multimorbid and non-multimorbid patients: a longitudinal cohort study in primary careBMJ Open 2019;9:e033545. doi: 10.1136/bmjopen-2019-033545
|
|
Abstract:Objectives To assess the risk of mortality in primary care patients, multimorbid (≥2 chronic conditions) or not, prescribed hypnotics/anxiolytics. Design A longitudinal cohort study Setting Primary healthcare in the Reykjavik area. Participants 114 084 individuals (aged 10-79 years, average 38.5, SD 18.4) contacting general practitioners during 2009-2012 (mortality follow-up to 31 December 2016). Of those, the reference group comprised 58 560 persons who were neither multimorbid nor had redeemed prescriptions for hypnotics/anxiolytics. Participants (16 108) redeeming prescriptions for hypnotics/anxiolytics on a regular basis for 3 consecutive years were considered as consistent, long-term users. They were subdivided into low-dose (1-300 defined daily doses (DDD)/3 years), medium-dose (301-1095 DDDs/3 years) and high-dose users (>1095 DDDs/3 years). All six groups taking these drugs were compared with the reference group. Main outcome measures All-cause mortality. Results HRs were calculated with the no multimorbidity-no drug group as a reference, using Cox proportional hazards regression model adjusting for age, sex and the number of chronic conditions (n=111 767), patients with cancer excluded. During follow-up, 516 358 person-years in total, 1926 persons died. Mean follow-up was 1685 days (4.6 years), range 1-1826 days (5.0 years). For all multimorbid patients who took no drugs the HR was 1.14 (95% CI 1.00 to 1.30) compared with those without multimorbidity. HRs in the non-multimorbid participants varied from 1.49 to 3.35 (95% CI ranging from 1.03 to 4.11) with increasing doses of hypnotics/anxiolytics, and correspondingly from 1.55 to 3.52 (1.18 to 4.29) in multimorbid patients. Conclusions Mortality increased in a dose-dependent manner among both multimorbid and non-multimorbid patients taking hypnotics/anxiolytics. This increase was clearly associated with prescribing of these drugs. Their use should be limited to the recommended period of 2-4 up to 6 weeks; long-term use may incur increased risk and should be re-examined.
|
|
Description:Publisher's version (útgefin grein).
|
|
Rights:This is an open access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non-commercially,
and license their derivative works on different terms, provided the original work is
properly cited, appropriate credit is given, any changes made indicated, and the use
is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
|