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Risk of pneumonia associated with incident benzodiazepine use among community-dwelling adults with Alzheimer disease.

Abstract Knowledge regarding whether benzodiazepines and similarly acting non-benzodiazepines (Z-drugs) are associated with an increased risk of pneumonia among older adults is lacking. We sought to investigate this association among community-dwelling adults with Alzheimer disease, a condition in which both sedative/hypnotic use and pneumonia are common.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title cmaj : canadian medical association journal = journal de l'association medicale canadienne
Publication Year Start




PMID- 28396328
OWN - NLM
STAT- MEDLINE
DA  - 20170411
DCOM- 20170419
LR  - 20170419
IS  - 1488-2329 (Electronic)
IS  - 0820-3946 (Linking)
VI  - 189
IP  - 14
DP  - 2017 Apr 10
TI  - Risk of pneumonia associated with incident benzodiazepine use among
      community-dwelling adults with Alzheimer disease.
PG  - E519-E529
LID - 10.1503/cmaj.160126 [doi]
AB  - BACKGROUND: Knowledge regarding whether benzodiazepines and similarly acting
      non-benzodiazepines (Z-drugs) are associated with an increased risk of pneumonia 
      among older adults is lacking. We sought to investigate this association among
      community-dwelling adults with Alzheimer disease, a condition in which both
      sedative/hypnotic use and pneumonia are common. METHODS: We obtained data on all 
      community-dwelling adults with a recent diagnosis of Alzheimer disease in Finland
      (2005-2011) from the Medication use and Alzheimer disease (MEDALZ) cohort, which 
      incorporates national registry data on prescriptions, reimbursement, hospital
      discharges and causes of death. Incident users of benzodiazepines and Z-drugs
      were identified using a 1-year washout period and matched with nonusers using
      propensity scores. The association with hospital admission or death due to
      pneumonia was analyzed with the Cox proportional hazards model and adjusted for
      use of other psychotropic drugs in a time-dependent manner. RESULTS: Among 49 484
      eligible participants with Alzheimer disease, 5232 taking benzodiazepines and
      3269 taking Z-drugs were matched 1:1 with those not taking these drugs.
      Collectively, use of benzodiazepines and Z-drugs was associated with an increased
      risk of pneumonia (adjusted hazard ratio [HR] 1.22, 95% confidence interval [CI] 
      1.05-1.42). When analyzed separately, benzodiazepine use was significantly
      associated with an increased risk of pneumonia (adjusted HR 1.28, 95% CI
      1.07-1.54), whereas Z-drug use was not (adjusted HR 1.10, 95% CI 0.84-1.44). The 
      risk of pneumonia was greatest within the first 30 days of benzodiazepine use (HR
      2.09, 95% CI 1.26-3.48). INTERPRETATION: Benzodiazepine use was associated with
      an increased risk of pneumonia among patients with Alzheimer disease. Risk of
      pneumonia should be considered when weighing the benefits and risks of
      benzodiazepines in this population.
CI  - (c) 2017 Canadian Medical Association or its licensors.
FAU - Taipale, Heidi
AU  - Taipale H
AD  - Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen,
      Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen,
      Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen),
      Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for 
      Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of 
      Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen,
      Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for
      Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology
      (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku,
      Finland; Department of Social Research (Sund), Centre for Research Methods,
      University of Helsinki, Helsinki, Finland; Department of Psychiatry
      (Hartikainen), Kuopio University Hospital, Kuopio, Finland [email protected]
FAU - Tolppanen, Anna-Maija
AU  - Tolppanen AM
AD  - Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen,
      Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen,
      Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen),
      Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for 
      Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of 
      Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen,
      Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for
      Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology
      (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku,
      Finland; Department of Social Research (Sund), Centre for Research Methods,
      University of Helsinki, Helsinki, Finland; Department of Psychiatry
      (Hartikainen), Kuopio University Hospital, Kuopio, Finland.
FAU - Koponen, Marjaana
AU  - Koponen M
AD  - Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen,
      Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen,
      Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen),
      Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for 
      Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of 
      Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen,
      Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for
      Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology
      (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku,
      Finland; Department of Social Research (Sund), Centre for Research Methods,
      University of Helsinki, Helsinki, Finland; Department of Psychiatry
      (Hartikainen), Kuopio University Hospital, Kuopio, Finland.
FAU - Tanskanen, Antti
AU  - Tanskanen A
AD  - Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen,
      Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen,
      Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen),
      Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for 
      Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of 
      Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen,
      Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for
      Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology
      (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku,
      Finland; Department of Social Research (Sund), Centre for Research Methods,
      University of Helsinki, Helsinki, Finland; Department of Psychiatry
      (Hartikainen), Kuopio University Hospital, Kuopio, Finland.
FAU - Lavikainen, Piia
AU  - Lavikainen P
AD  - Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen,
      Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen,
      Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen),
      Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for 
      Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of 
      Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen,
      Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for
      Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology
      (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku,
      Finland; Department of Social Research (Sund), Centre for Research Methods,
      University of Helsinki, Helsinki, Finland; Department of Psychiatry
      (Hartikainen), Kuopio University Hospital, Kuopio, Finland.
FAU - Sund, Reijo
AU  - Sund R
AD  - Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen,
      Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen,
      Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen),
      Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for 
      Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of 
      Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen,
      Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for
      Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology
      (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku,
      Finland; Department of Social Research (Sund), Centre for Research Methods,
      University of Helsinki, Helsinki, Finland; Department of Psychiatry
      (Hartikainen), Kuopio University Hospital, Kuopio, Finland.
FAU - Tiihonen, Jari
AU  - Tiihonen J
AD  - Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen,
      Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen,
      Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen),
      Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for 
      Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of 
      Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen,
      Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for
      Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology
      (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku,
      Finland; Department of Social Research (Sund), Centre for Research Methods,
      University of Helsinki, Helsinki, Finland; Department of Psychiatry
      (Hartikainen), Kuopio University Hospital, Kuopio, Finland.
FAU - Hartikainen, Sirpa
AU  - Hartikainen S
AD  - Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen,
      Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen,
      Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen),
      Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for 
      Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of 
      Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen,
      Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for
      Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology
      (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku,
      Finland; Department of Social Research (Sund), Centre for Research Methods,
      University of Helsinki, Helsinki, Finland; Department of Psychiatry
      (Hartikainen), Kuopio University Hospital, Kuopio, Finland.
LA  - eng
PT  - Journal Article
PL  - Canada
TA  - CMAJ
JT  - CMAJ : Canadian Medical Association journal = journal de l'Association medicale
      canadienne
JID - 9711805
RN  - 0 (Hypnotics and Sedatives)
RN  - 12794-10-4 (Benzodiazepines)
SB  - AIM
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Alzheimer Disease/*drug therapy
MH  - Benzodiazepines/*adverse effects
MH  - Comorbidity
MH  - Female
MH  - Finland
MH  - Humans
MH  - Hypnotics and Sedatives/*adverse effects
MH  - Logistic Models
MH  - Male
MH  - Patient Discharge
MH  - Pneumonia/*epidemiology
MH  - Proportional Hazards Models
MH  - Registries
MH  - Risk Factors
PMC - PMC5386845
EDAT- 2017/04/12 06:00
MHDA- 2017/04/20 06:00
CRDT- 2017/04/12 06:00
PHST- 2016/12/30 [accepted]
AID - 189/14/E519 [pii]
AID - 10.1503/cmaj.160126 [doi]
PST - ppublish
SO  - CMAJ. 2017 Apr 10;189(14):E519-E529. doi: 10.1503/cmaj.160126.

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