Hypnotics' association with mortality or cancer: a matched cohort study

Area of Science:

• Pharmacology
• Public Health
• Epidemiology

Background:

• Hypnotic drug use for insomnia is prevalent, with 6%-10% of US adults using them in 2010.
• Previous research suggests a potential link between hypnotic use and increased mortality.
• This study aimed to further investigate this association using a large patient cohort.

Purpose of the Study:

• To determine the association between hypnotic drug prescriptions and all-cause mortality.
• To examine the dose-response relationship between hypnotic use and mortality.
• To assess the impact of hypnotic use on cancer incidence.

Main Methods:

• A matched cohort survival analysis was conducted using longitudinal electronic medical records.
• 10,529 patients with hypnotic prescriptions were matched with 23,676 controls without prescriptions.
• Data were adjusted for multiple risk factors, and Cox proportional hazards models were used with extensive comorbidity matching.

Main Results:

• Patients prescribed any hypnotic drug showed substantially elevated hazards of dying (HRs ranging from 3.60 to 5.32).
• A clear dose-response association was observed, with higher hypnotic doses correlating with increased mortality risk.
• Hypnotic use was also associated with a significant elevation in incident cancer (HR=1.35), independent of pre-existing conditions.

Conclusions:

• Prescription hypnotic use is associated with a greater than threefold increased hazard of death, even at low annual pill counts (<18).
• This association was consistent across various commonly prescribed hypnotics, including newer short-acting agents.
• The observed excess mortality and cancer risk are not attributable to selective prescription for patients with poorer health.