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The association between benzodiazepines and influenza‐like illness‐related pneumonia and mortality: a survival analysis using UK Primary Care data
Author(s) -
Nakafero Georgina,
Sanders Robert D.,
NguyenVanTam Jonathan S.,
Myles Puja R.
Publication year - 2016
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4028
Subject(s) - medicine , pneumonia , hazard ratio , zopiclone , influenza like illness , confidence interval , proportional hazards model , mortality rate , intensive care medicine , anesthesia , hypnotic , immunology , virus
Purpose Bacterial superinfections, including pneumonia, are frequent complications of influenza‐like illness (ILI). Clinical and laboratory evidence suggests that benzodiazepines and Z‐drugs may influence susceptibility to infections and mortality. We investigated whether benzodiazepines and zopiclone modify the occurrence of ILI‐related pneumonia and mortality. Methods We obtained data on 804 051 ILI patients from a comprehensive primary care database, the Clinical Practice Research Datalink. The follow‐up period started from the diagnosis of ILI for 30 days. Pneumonia and deaths occurring within the 30‐day follow‐up period were considered as potentially ‘ILI related’. Exposure to benzodiazepines and zopiclone was determined in the period preceding a diagnosis of ILI with current use defined as a prescription for benzodiazepines in the month prior to ILI diagnosis. Cox regression was used for the analyses. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) are presented. Results Influenza‐like illness‐related pneumonia and mortality were noted in 1117 and 707 ILI patients, respectively. Current exposure to benzodiazepines was associated with increased occurrence of both ILI‐related pneumonia and mortality (ILI‐related pneumonia adjusted HR 4.24, 95%CI [2.27, 7.95]; ILI‐related mortality adjusted HR 20.69, 95%CI [15.54, 27.54]). A similar increase in ILI‐related mortality but not pneumonia was observed with current zopiclone use (ILI‐related mortality adjusted HR 10.86, 95%CI [6.93, 17.02]; ILI‐related pneumonia adjusted HR 1.97, 95%CI [0.63, 6.12]). Conclusion Benzodiazepines may increase the likelihood of pneumonia and mortality related to ILI. A cautionary approach to prescribing benzodiazepine is suggested in people known to be at increased risk of pneumonia or mortality. Copyright © 2016 John Wiley & Sons, Ltd.