Trajectories in hypnotic use and approaching death : a register linked case–control study

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Kronholm , E , Jousilahti , P , Laatikainen , T , Lallukka , T , Peltonen , M , Seppänen , J & Virta , L 2019 , ' Trajectories in hypnotic use and approaching death : a register linked case–control study ' , Sleep Medicine , vol. 57 , pp. 153-161 . https://doi.org/10.1016/j.sleep.2018.02.005

Title: Trajectories in hypnotic use and approaching death : a register linked case–control study
Author: Kronholm, Erkki; Jousilahti, Pekka; Laatikainen, Tiina; Lallukka, Tea; Peltonen, Markku; Seppänen, Johanna; Virta, Lauri
Contributor: University of Helsinki, National Institute for Health and Welfare (THL)
University of Helsinki, Clinicum
Date: 2019-05
Language: eng
Number of pages: 9
Belongs to series: Sleep Medicine
ISSN: 1389-9457
URI: http://hdl.handle.net/10138/301735
Abstract: Purpose: Whether the association between hypnotic and increased mortality risk is created by causation or confounding, has been long debated. We further examined the possibility of confounding by indication with a comprehensive approach. Methods: The National FINRISK Study cohorts of 1997, 2002, and 2007 (25,436 participants aged 25-74) were followed up until July 2012. There were 1822 deaths, and at least one gender, baseline age and cohort matched 'control' was found for 1728 'cases' yielding a final analytical sample of 3955 individuals. An index age, equivalent to the age at death of their respective cases' was set for each control. Hypnotic drug purchases were followed from the Finnish nationwide register during a 36-month run-up period before the date of death/index date. The prevalence and incidence of hypnotic purchases were compared between cases and matched controls. Moreover, latent developmental trajectories of purchases were modelled and their relations with specific and all-cause death risks were analysed. Results: An increasing difference between cases and controls was observed as regards the use of hypnotic drugs. During the last 30 months before the date of death/index date, the rate ratio of incident purchases between cases and controls was 2.37 (95% CL, 1.79-3.12) among older and 3.61 (95% CL, 2.37-5.89) among younger individuals. The developmental trajectories of hypnotic drug purchases were differently and by interpretation plausibly associated with specific mortality risks. Conclusions: In most cases the association between hypnotics and mortality risk is created by symptomatic treatment when death is approaching. (c) 2018 Elsevier B.V. All rights reserved.
Subject: BENZODIAZEPINES
Benzodiazepines
Death causes
Hypnotics
INCREASE
INSOMNIA
MORTALITY
Mortality
PREVALENCE
PSYCHOMOTOR
RISK
SLEEP
TEMAZEPAM
Z-hypnotics
ZOPICLONE
3142 Public health care science, environmental and occupational health
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