ArticleEuropean journal of clinical pharmacology2015
Association between hypnotics use and increased mortality: causation or confounding?
Article in European journal of clinical pharmacology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 39 citations in OpenAlex.
- Association between sedative prescriptions after hospital discharge and falls and other adverse events in older adults: a population-based cohort study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026Article
- Acute cardiovascular effects associated with the use of prescription medications: A Danish nationwide screening study.British journal of clinical pharmacology · 2025Article
- Opioids in Treatment of Refractory Dyspnea in Chronic Obstructive Pulmonary Disease: Yes, No or Maybe.Journal of personalized medicine · 2024Review
- Association Between Hypnotic Use and All-Cause Mortality in Patients with Chronic Obstructive Pulmonary Disease and Insomnia.International journal of chronic obstructive pulmonary disease · 2023Article
- Use of prescription benzodiazepines and related drugs in family caregivers: a nation-wide register-based study.Age and ageing · 2022Article
- Observational
- Mortality and concurrent use of opioids and hypnotics in older patients: A retrospective cohort study.PLoS medicine · 2021Article
- Pharmacological Management of Insomnia.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2021Review
- Non-benzodiazepine hypnotic use for sleep disturbance in people aged over 55 years living with dementia: a series of cohort studies.Health technology assessment (Winchester, England) · 2021Article
- Adverse effects of Z-drugs for sleep disturbance in people living with dementia: a population-based cohort study.BMC medicine · 2020Article
- Sleep, insomnia, and depression.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2020Review
- Article
- Article
- Article
- Use of benzodiazepines and cardiovascular mortality in a cohort of women aged over 50 years.European journal of clinical pharmacology · 2018Article
- Benzodiazepines and risk of all cause mortality in adults: cohort study.BMJ (Clinical research ed.) · 2017Article
- Multimorbidity and use of hypnotic and anxiolytic drugs: cross-sectional and follow-up study in primary healthcare in Iceland.BMC family practice · 2016Article
- Mortality Risk of Hypnotics: Strengths and Limits of Evidence.Drug safety · 2016Review
- Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit.F1000Research · 2016Review
- Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeMany research studies have found associations between benzodiazepines and/or z-hypnotics (BZZ) and increasing mortality, leading to a discussion about causation or confounding. This study suggests a factor that could produce this association through confounding.
methodsThe Norwegian population in 2010 supplied 8862 deaths ages 41-80 and 898,289 controls. Index dates were added to control records which corresponded to death dates. BZZ use was recorded for 2 years before death/index date.
resultsPersons exposed to BZZ were more likely (OR = 2.3) to die than those who were not. With proximity of death, increasingly larger proportions of the prospective deaths received prescriptions for BZZ, until in the last 2 months 40-45% received BZZ. The frequency of BZZ use in controls increased with age as opposed to the death cohort where all ages showed similar rates of BZZ use. In the last few months before death, the youngest age group had an OR = 5.8 for BZZ use while the oldest age group an OR = 1.8, adjusted for age and sex. Opioid use showed a similar pattern of increasing use near death.
conclusionsThe increased use of BZZ with approaching death is consistent with increasing symptomatic treatment in terminal illness. Thus, the association of BZZ and mortality is more likely to be due to confounding than to causality. Further evidence from this and other research includes similar use patterns for other drugs such as opioids, the lack of specificity in cause of death and the size of the association regarding age and time to death.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.