Mitchell Levine, MD
Are hypnotic drugs associated with increased risk for mortality or cancer?
Matched cohort study using data from longitudinal electronic health records of an integrated health system linked to the US Social Security Death Index. Mean follow-up was 2.5 years.
Geisinger Health System in Pennsylvania, USA.
34 205 primary care patients ≥ 18 years of age (mean age 54 y, 63% women) who had ≥ 1 outpatient visit between January 2002 and September 2006. 10 529 patients had ≥ 1 prescription for a hypnotic drug that seemed to be prescribed for bedtime use, was indicated for insomnia by the US Food and Drug Administration, and was commonly prescribed in the electronic health records (hypnotics group). 23 676 patients without a prescription for hypnotics at any time were matched 2:1 with the hypnotics group based on sex, age (within 5 y), smoking status, and observation period (control group). Patients had to have ≥ 3 months of follow-up after prescription (hypnotics group) or ≥ 3 months of observation (control group). Patients with major cancer diagnosed < 18 days after the start of the observation period were excluded.
Prescription of hypnotic drugs. Analyses were stratified by comorbid condition and adjusted for age, sex, ethnicity, body mass index, marital status, smoking status, and self-reported alcohol use.
Death and cancer.
41% of patients were prescribed zolpidem only and 20% temazepam only. 6.1% of users of hypnotics died compared with 1.2% of nonusers. Hypnotics at any dose were associated with greater risk for death; higher doses were associated with greater risk for cancer (Table).
Hypnotic drugs at any dose were associated with increased risk for death; higher doses were associated with increased risk for cancer.
Association between hypnotic drugs and mortality or cancer*
*CI defined in Glossary.
†Stratified by comorbid condition and adjusted for age, sex, ethnicity, body mass index, marital status, smoking status, and self-reported alcohol use.
‡Excluding nonmelanoma skin cancer.
§Provided by author.
Levine M. Hypnotic drugs were associated with increased risk for mortality. Ann Intern Med. ;156:JC6–13. doi: 10.7326/0003-4819-156-12-201206190-02013
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Published: Ann Intern Med. 2012;156(12):JC6-13.
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