Dataset Information

Benzodiazepines and risk of all cause mortality in adults: cohort study.

ABSTRACT: Objectives To evaluate the risk of all cause mortality associated with initiating compared with not initiating benzodiazepines in adults, and to address potential treatment barriers and confounding related to the use of a non-active comparator group.Design Retrospective cohort study.Setting Large de-identified US commercial healthcare database (Optum Clinformatics Datamart).Participants 1:1 high dimensional propensity score matched cohort of benzodiazepine initiators, and randomly selected benzodiazepine non-initiators with a medical visit within 14 days of the start of benzodiazepine treatment (n=1?252?988), between July 2004 and December 2013. To address treatment barriers and confounding, patients were required to have filled one or more prescriptions for any medication in the 90 days and 91-180 days before the index date (ie, the date of starting benzodiazepine treatment for initiators and the date of the selected medical visit for benzodiazepine non-initiators) and the high dimensional propensity score was estimated on the basis of more than 300 covariates.Main outcome measure All cause mortality, determined by linkage with the Social Security Administration Death Master File.Results Over a six month follow-up period, 5061 and 4691 deaths occurred among high dimensional propensity score matched benzodiazepine initiators versus non-initiators (9.3 v 9.4 events per 1000 person years; hazard ratio 1.00, 95% confidence interval 0.96 to 1.04). A 4% (95% confidence interval 1% to 8%) to 9% (2% to 7%) increase in mortality risk was observed associated with the start of benzodiazepine treatment for follow-ups of 12 and 48 months and in subgroups of younger patients and patients initiating short acting agents. In secondary analyses comparing 1:1 high dimensional propensity score matched patients initiating benzodiazepines with an active comparator, ie, patients starting treatment with selective serotonin reuptake inhibitor antidepressants, benzodiazepine use was associated with a 9% (95% confidence interval 3% to 16%) increased risk.Conclusions This large population based cohort study suggests either no increase or at most a minor increase in risk of all cause mortality associated with benzodiazepine initiation. If a detrimental effect exists, it is likely to be much smaller than previously stated and to have uncertain clinical relevance. Residual confounding likely explains at least part of the small increase in mortality risk observed in selected analyses.

SUBMITTER: Patorno E

PROVIDER: S-EPMC5499256 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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Benzodiazepines and risk of all cause mortality in adults: cohort study.

Patorno Elisabetta E Glynn Robert J RJ Levin Raisa R Lee Moa P MP Huybrechts Krista F KF

BMJ (Clinical research ed.) 20170706

Objectives To evaluate the risk of all cause mortality associated with initiating compared with not initiating benzodiazepines in adults, and to address potential treatment barriers and confounding related to the use of a non-active comparator group.Design Retrospective cohort study.Setting Large de-identified US commercial healthcare database (Optum Clinformatics Datamart).Participants 1:1 high dimensional propensity score matched cohort of benzodiazepine initiators, ...[more]

PMID: 28684397

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Project description:OBJECTIVE:To determine the association between recommended physical activity according to the 2018 physical activity guidelines for Americans and all cause and cause specific mortality using a nationally representative sample of US adults. DESIGN:Population based cohort study. SETTING:National Health Interview Survey (1997-2014) with linkage to the National Death Index records to 31 December 2015. PARTICIPANTS:479 856 adults aged 18 years or older. EXPOSURES:Participant self-reports of the amount of leisure time spent in aerobic physical activity and muscle strengthening activity each week were combined and categorised into four groups: insufficient activity, aerobic activity only, muscle strengthening only, and both aerobic and muscle strengthening activities according to the physical activity guidelines. MAIN OUTCOME MEASURES:All cause mortality and cause specific mortality (cardiovascular disease, cancer, chronic lower respiratory tract diseases, accidents and injuries, Alzheimer's disease, diabetes mellitus, influenza and pneumonia, and nephritis, nephrotic syndrome, or nephrosis) obtained from the National Death Index records. RESULTS:During a median follow-up of 8.75 years, 59 819 adults died from all causes, 13 509 from cardiovascular disease, 14 375 from cancer, 3188 from chronic lower respiratory tract diseases, 2477 from accidents and injuries, 1470 from Alzheimer's disease, 1803 from diabetes mellitus, 1135 from influenza and pneumonia, and 1129 from nephritis, nephrotic syndrome, or nephrosis. Compared with those who did not meet the physical activity guidelines (n=268 193), those who engaged in recommended muscle strengthening activity (n=21 428; hazard ratio 0.89, 95% confidence interval 0.85 to 0.94) or aerobic activity (n=113 851; 0.71, 0.69 to 0.72) were found to be at reduced risk of all cause mortality; and even larger survival benefits were found in those engaged in both activities (n=76 384; 0.60, 0.57 to 0.62). In addition, similar patterns were reported for cause specific mortality from cardiovascular disease, cancer, and chronic lower respiratory tract diseases. CONCLUSIONS:Adults who engage in leisure time aerobic and muscle strengthening activities at levels recommended by the 2018 physical activity guidelines for Americans show greatly reduced risk of all cause and cause specific mortality. These data suggest that the physical activity levels recommended in the guidelines are associated with important survival benefits.

Project description:BackgroundPrevious data on the association between central obesity and mortality are controversial. The aim of this study was to determine the associations between central obesity, as measured by the waist-to-height ratio (WtHR) and waist circumference (WC), with all cause and cause-specific mortality in U.S. adults.MethodsThe study subjects comprised a nationally representative sample of 33,569 adults >20 years of age who were recruited in the National Health and Nutrition Examination Survey between 1999 and 2014. Anthropometric data, including weight, height, and WC, were measured at each of the eight waves using consistent methodology. Death and underlying causes of death were ascertained through 31 December 2015. The association between central obesity and mortality were determined using weighted Cox proportional hazards regression models.ResultsA total of 4013 deaths occurred during a median follow-up of 7.33 years (263,029 person-years). Compared with the subjects in WtHR tertile 1, the subjects in tertiles 2 and 3 were at a higher risk of mortality from all-cause (tertile 2-hazard ratio [HR]: 1.29; 95% confidence interval [CI]: 1.13-1.47; tertile 3-HR: 1.96; 95% CI: 1.64-2.34) and cardiovascular diseases [CVDs] (tertile 2-HR: 1.40; 95% CI: 1.09-1.79; tertile 3-HR: 2.00; 95% CI: 1.47-2.73). Similarly, compared with the subjects in WC tertile 1, the subjects in tertiles 2 and 3 were at a higher risk of mortality from all-cause (tertile 2-HR: 1.15; 95% CI: 1.00-1.31; tertile 3-HR: 1.39; 95% CI: 1.15-1.67) and CVD (tertile 2-HR: 1.48; 95% CI: 1.14-1.93; tertile 3-HR: 1.74; 95% CI: 1.26-2.42). Restricted cubic spline analyses revealed an S-shaped and linear dose-relationship between WtHR and WC with all-cause mortality. Moreover, a WtHR> 0.58 or a WC > 0.98m was shown to be a risk factor for all-cause mortality.ConclusionsCentral obesity was significantly associated with increased risk of all-cause and CVD-related mortality, especially heart diseases-related mortality, even among normal weight adults. In addition to weight control, guideline designer should provide recommendations for people to decrease abdominal fat accumulation, in their effort to reduce mortality risk in later life.

Dataset Information

Benzodiazepines and risk of all cause mortality in adults: cohort study.

Publications

Benzodiazepines and risk of all cause mortality in adults: cohort study.

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