老年人使用苯二氮䓬类药物与机动车碰撞风险

Benzodiazepine use and the risk of motor vehicle crash in the elderly.

作者信息

Hemmelgarn B, Suissa S, Huang A, Boivin J F, Pinard G

机构信息

Department of Epidemiology and Biostatistics, McGill University and Royal Victoria Hospital, Montreal, Québec, Canada.

出版信息

JAMA. 1997 Jul 2;278(1):27-31.

PMID:9207334

Abstract

CONTEXT

Benzodiazepines, used by a sizable number of the elderly population, may affect the ability to drive and thus increase the risk of a motor vehicle crash. Epidemiologic studies of this question have produced inconsistent results that may be due to the different effects of long- and short-half-life benzodiazepines and variations in their duration of use.

OBJECTIVE

To determine whether the use of benzodiazepines of either long- or short-elimination half-life is associated with the risk of injurious motor vehicle crash in the elderly.

DESIGN AND SETTING

Nested case-control design within a cohort of 224,734 drivers from the Canadian province of Quebec, aged 67 to 84 years, followed up from 1990 to 1993. Computerized data for the study were obtained from provincial driver's license files, police reports of injurious crashes, and health insurance records.

PATIENTS

We identified all 5579 drivers involved in an injurious crash (cases) and a random sample of 10 controls per case selected from a subcohort of 13,256 subjects.

MAIN OUTCOME

Involvement of a cohort member as a driver in a motor vehicle crash in which at least 1 person (not necessarily the driver) sustained bodily injury.

RESULTS

The adjusted rate ratio of crash involvement within the first week of long-half-life benzodiazepine use was 1.45 (95% confidence interval [CI], 1.04-2.03). The rate ratio for continuous use of longer duration up to 1 year was slightly lower but remained significant (rate ratio, 1.26; 95% CI, 1.09-1.45). In contrast, there was no increased risk after the initiation of treatment with short-half-life benzodiazepines (rate ratio, 1.04; 95% CI, 0.81-1.34) or with their continued use (rate ratio, 0.91; 95% CI, 0.82-1.01).

CONCLUSIONS

Brief or extended periods of exposure to long-half-life benzodiazepines are associated with an increased risk of motor vehicle crash involvement in the elderly population. There is no such elevated risk for short-half-life benzodiazepines.

摘要

背景

相当一部分老年人群使用苯二氮䓬类药物，这类药物可能会影响驾驶能力，从而增加机动车碰撞事故的风险。关于这个问题的流行病学研究结果并不一致，这可能是由于长半衰期和短半衰期苯二氮䓬类药物的不同作用以及它们使用时长的差异。

目的

确定使用长消除半衰期或短消除半衰期的苯二氮䓬类药物是否与老年人机动车碰撞致伤风险相关。

设计与背景

在加拿大魁北克省224,734名年龄在67至84岁的驾驶员队列中进行巢式病例对照研究，随访时间为1990年至1993年。该研究的计算机化数据来自省级驾照档案、机动车碰撞致伤警方报告和医疗保险记录。

研究对象

我们确定了所有5579名涉及碰撞致伤事故的驾驶员（病例），并从13,256名受试者的子队列中为每个病例随机选取10名对照。

主要结局

队列成员作为驾驶员参与机动车碰撞事故，且至少有1人（不一定是驾驶员）身体受伤。

结果

使用长半衰期苯二氮䓬类药物第一周内碰撞事故参与的调整率比为1.45（95%置信区间[CI]，1.04 - 2.03）。持续使用长达1年的时长的率比略低但仍具有显著性（率比，1.26；95% CI，1.09 - 1.45）。相比之下，开始使用短半衰期苯二氮䓬类药物治疗后（率比，1.04；95% CI，0.81 - 1.34）或持续使用（率比，0.91；95% CI，0.82 - 1.01），风险并未增加。