Clearing the confounding confusion: Benzodiazepines and the risk of dementia?

IF 3.5 3区 医学 Q2 GERIATRICS & GERONTOLOGY
Kevin J Friesen , Jamie Falk , I Fan Kuo , Alexander Singer , Shawn Bugden
{"title":"Clearing the confounding confusion: Benzodiazepines and the risk of dementia?","authors":"Kevin J Friesen ,&nbsp;Jamie Falk ,&nbsp;I Fan Kuo ,&nbsp;Alexander Singer ,&nbsp;Shawn Bugden","doi":"10.1016/j.archger.2025.105850","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To examine the relationship between duration of benzodiazepine exposure and the risk of dementia.</div></div><div><h3>Design</h3><div>A retrospective cohort study using administrative health data followed 3 age-based strata (ages 55, 65 and 75) for up to a maximum of 22 years to examine risk of dementia due to benzodiazepine use. Each stratum was analyzed as a whole, then restricted to persons with depression or anxiety, and finally using high dimension propensity scores (HDPS) matched cohort.</div></div><div><h3>Setting</h3><div>We used administrative data on subjects receiving standard medical care in Manitoba, Canada.</div></div><div><h3>Measurements</h3><div>Prescription data was used to quantify benzodiazepine using cumulative defined-daily-dose (DDD). Comorbidities and cases of dementia were determined using medical and hospital data.</div></div><div><h3>Results</h3><div>Dementia risk in high-dose users of the youngest strata was elevated compared to non-users (adjusted HR (aHR) 1.33; 95 % CI 1.05–1.68)). Little to no difference was found in the middle (aHR 1.17; 1.02–1.33) and oldest strata (aHR 1.02; 0.93–1.11). Restriction to persons with depression or anxiety eliminated the association. No association was found using HDPS-matched comparison groups.</div></div><div><h3>Conclusions</h3><div>Only a modest increase in dementia risk was seen in the high-dose benzodiazepine users. This association appears to be driven by the confounding due to higher rates of diabetes, cardiovascular disease, depression, and anxiety among users. Using restriction or HDPS to better control for confounding effects eliminates the association. While benzodiazepines do not appear to be a significant risk factor for dementia, tolerance, dependency and adverse effects caution against their long-term use.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"134 ","pages":"Article 105850"},"PeriodicalIF":3.5000,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of gerontology and geriatrics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0167494325001086","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Objective

To examine the relationship between duration of benzodiazepine exposure and the risk of dementia.

Design

A retrospective cohort study using administrative health data followed 3 age-based strata (ages 55, 65 and 75) for up to a maximum of 22 years to examine risk of dementia due to benzodiazepine use. Each stratum was analyzed as a whole, then restricted to persons with depression or anxiety, and finally using high dimension propensity scores (HDPS) matched cohort.

Setting

We used administrative data on subjects receiving standard medical care in Manitoba, Canada.

Measurements

Prescription data was used to quantify benzodiazepine using cumulative defined-daily-dose (DDD). Comorbidities and cases of dementia were determined using medical and hospital data.

Results

Dementia risk in high-dose users of the youngest strata was elevated compared to non-users (adjusted HR (aHR) 1.33; 95 % CI 1.05–1.68)). Little to no difference was found in the middle (aHR 1.17; 1.02–1.33) and oldest strata (aHR 1.02; 0.93–1.11). Restriction to persons with depression or anxiety eliminated the association. No association was found using HDPS-matched comparison groups.

Conclusions

Only a modest increase in dementia risk was seen in the high-dose benzodiazepine users. This association appears to be driven by the confounding due to higher rates of diabetes, cardiovascular disease, depression, and anxiety among users. Using restriction or HDPS to better control for confounding effects eliminates the association. While benzodiazepines do not appear to be a significant risk factor for dementia, tolerance, dependency and adverse effects caution against their long-term use.
澄清困惑:苯二氮卓类药物与痴呆风险?
目的探讨苯二氮卓类药物暴露时间与痴呆风险的关系。设计一项回顾性队列研究,利用行政卫生数据对3个年龄层(55岁、65岁和75岁)进行最长22年的跟踪调查,以检查苯二氮卓类药物使用导致痴呆的风险。每个阶层作为一个整体进行分析,然后限制抑郁或焦虑的人,最后使用高维倾向得分(HDPS)匹配队列。我们使用加拿大马尼托巴省接受标准医疗护理的受试者的管理数据。测量方法:处方数据采用累积限定日剂量(DDD)定量苯二氮卓。使用医疗和医院数据确定痴呆的合并症和病例。结果高剂量服用者与非服用者相比,最年轻阶层的痴呆风险升高(调整HR (aHR) 1.33;95% ci 1.05-1.68))。中间部分差异不大或无差异(aHR 1.17;1.02 - 1.33)和最古老地层(aHR 1.02;0.93 - -1.11)。对抑郁症或焦虑症患者的限制消除了这种联系。在hdps匹配的对照组中没有发现关联。结论:在高剂量苯二氮卓类药物使用者中,痴呆风险仅略有增加。这种关联似乎是由使用者中较高的糖尿病、心血管疾病、抑郁和焦虑率引起的混淆所驱动的。使用限制或HDPS来更好地控制混杂效应可以消除这种关联。虽然苯二氮卓类药物似乎不是痴呆的重要风险因素,但长期使用它们的耐受性、依赖性和不良影响都值得警惕。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
7.30
自引率
5.00%
发文量
198
审稿时长
16 days
期刊介绍: Archives of Gerontology and Geriatrics provides a medium for the publication of papers from the fields of experimental gerontology and clinical and social geriatrics. The principal aim of the journal is to facilitate the exchange of information between specialists in these three fields of gerontological research. Experimental papers dealing with the basic mechanisms of aging at molecular, cellular, tissue or organ levels will be published. Clinical papers will be accepted if they provide sufficiently new information or are of fundamental importance for the knowledge of human aging. Purely descriptive clinical papers will be accepted only if the results permit further interpretation. Papers dealing with anti-aging pharmacological preparations in humans are welcome. Papers on the social aspects of geriatrics will be accepted if they are of general interest regarding the epidemiology of aging and the efficiency and working methods of the social organizations for the health care of the elderly.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信