1 MedImpact, San Diego, California.
2 Kaiser Permanente Southern California, Downey, California.
J Manag Care Spec Pharm. 2016 Aug;22(8):932-8. doi: 10.18553/jmcp.2016.22.8.932.
Previous studies have shown an increased risk of pneumonia with benzodiazepines (BZD) and an increased risk of any infection with non-BZD hypnotics, but no analysis has specifically investigated the risk of pneumonia with non-BZD hypnotic use.
To evaluate the risk of pneumonia associated with non-BZD hypnotic use in the elderly.
This was a retrospective case-control study of members aged 65 years and older enrolled in an integrated health care system. Cases were identified as patients aged 65 years and older with a diagnosis of pneumonia from January 2011 to December 2012. Controls were matched in a 4:1 ratio to cases based on age, gender, and active enrollment. Non-BZD hypnotic exposure was evaluated for all cases and controls 1 year before the index date. Proximity of exposure to index date and duration of use were analyzed. Conditional logistic regression adjusted for covariates was performed.
We identified 51,029 cases with pneumonia and matched 188,391 controls without pneumonia. Of the cases with pneumonia, 5.5% (2,790) of cases had exposure to a non-BZD hypnotic, compared with 3.4% (6,345) of controls. Non-BZD hypnotic exposure was associated with an increased risk of pneumonia (OR = 1.14; 95% CI = 1.08-1.20). When exposure was stratified by proximity to index date, only current exposure was associated with an increased risk of pneumonia (OR = 1.27; 95% CI = 1.18-1.36). Short-term exposure was associated with a relatively higher risk of pneumonia (OR = 1.57; 95% CI = 1.39-1.77) compared with long-term use (OR = 1.16; 95% CI = 1.06-1.25).
Current use of non-BZD hypnotics in older adults is associated with an increased risk of pneumonia. The findings of this study provide additional support for reducing the use of non-BZD hypnotics in older adults and for pursuing safer alternatives for treating insomnia.
No outside funding supported this study. At the time of this study, Jung was a PGY2 resident in drug information at Kaiser Permanente Drug Information Services. All authors are employed by Kaiser Permanente and report no other potential financial conflicts of interest. Study concept and design were contributed by Jung, Spence, Lee, and Gibbs. Jung, Spence, and Hui were responsible for data collection, and data interpretation was performed by Jung and Spence, with assistance from Escasa, Lee, and Hui. The manuscript was primarily written by Jung, along with Spence and Escasa, and revised by Spence, Escasa, and Lee, along with the other authors.
先前的研究表明，苯二氮䓬类药物（BZD）与肺炎风险增加有关，而非苯二氮䓬类催眠药与任何感染风险增加有关，但尚无分析专门研究非苯二氮䓬类催眠药使用与肺炎风险之间的关系。
评估老年人群中非苯二氮䓬类催眠药使用与肺炎相关的风险。
这是一项回顾性病例对照研究，纳入了参加综合医疗保健系统的年龄在 65 岁及以上的成员。病例定义为年龄在 65 岁及以上，在 2011 年 1 月至 2012 年 12 月期间诊断为肺炎的患者。对照组按年龄、性别和活跃参保情况以 4:1 的比例与病例相匹配。对所有病例和对照组在索引日期前 1 年进行非苯二氮䓬类催眠药暴露评估。分析暴露与索引日期的接近程度和使用时间的长短。采用调整了协变量的条件逻辑回归进行分析。
我们确定了 51,029 例肺炎病例，并匹配了 188,391 例无肺炎的对照。在肺炎病例中，5.5%（2790 例）的病例有非苯二氮䓬类催眠药暴露，而对照组为 3.4%（6345 例）。非苯二氮䓬类催眠药暴露与肺炎风险增加相关（OR=1.14；95%CI=1.08-1.20）。当按与索引日期的接近程度对暴露进行分层时，仅当前暴露与肺炎风险增加相关（OR=1.27；95%CI=1.18-1.36）。短期暴露与肺炎风险增加相关（OR=1.57；95%CI=1.39-1.77），而长期使用与肺炎风险增加相关（OR=1.16；95%CI=1.06-1.25）。
老年人群中当前使用非苯二氮䓬类催眠药与肺炎风险增加相关。本研究结果为减少老年人群中非苯二氮䓬类催眠药的使用以及寻求更安全的替代药物治疗失眠症提供了额外支持。
本研究无外部资金支持。在进行本研究时，Jung 是 Kaiser Permanente 药物信息服务处的住院药师。所有作者均受雇于 Kaiser Permanente，无其他潜在财务利益冲突。Jung、Spence、Lee 和 Gibbs 为研究概念和设计做出了贡献。Jung、Spence 和 Hui 负责数据收集，Jung 和 Spence 进行数据解释，并在 Escasa、Lee 和 Hui 的协助下进行。初稿由 Jung 撰写，Spence 和 Escasa 参与修订，Lee 以及其他作者参与了修订。
