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The association between benzodiazepines and influenza-like illness-related pneumonia and mortality: a survival analysis using UK Primary Care data

Nakafero, Georgina; Sanders, Robert D.; Nguyen-Van-Tam, Jonathan S.; Myles, Puja R.

The association between benzodiazepines and influenza-like illness-related pneumonia and mortality: a survival analysis using UK Primary Care data Thumbnail


Authors

Robert D. Sanders

Puja R. Myles



Abstract

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.

Journal Article Type Article
Acceptance Date Apr 20, 2016
Online Publication Date May 23, 2016
Publication Date 2016-11
Deposit Date Jun 16, 2016
Publicly Available Date Jun 16, 2016
Journal Pharmacoepidemiology and Drug Safety
Print ISSN 1053-8569
Electronic ISSN 1099-1557
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 25
Issue 11
Pages 1263-1273
DOI https://doi.org/10.1002/pds.4028
Keywords benzodiazepines
zopiclone
influenza-like illness
pneumonia
mortality
pharmacoepidemiology
Public URL https://nottingham-repository.worktribe.com/output/788947
Publisher URL http://onlinelibrary.wiley.com/doi/10.1002/pds.4028/abstract
Related Public URLs http://dx.doi.org/10.1002/pds.4028