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Uncertain Association Between Benzodiazepine Use and the Risk of Dementia: A Cohort Study

Authors
 Yeon-Hee Baek  ;  Hyesung Lee  ;  Woo Jung Kim  ;  Jee-Eun Chung  ;  Nicole Pratt  ;  Lisa Kalisch Ellett  ;  Ju-Young Shin 
Citation
 JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, Vol.21(2) : 201-211.e2, 2020-02 
Journal Title
 JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION 
ISSN
 1525-8610 
Issue Date
2020-02
Keywords
Dementia ; benzodiazepine ; cohort studies ; propensity score
Abstract
Objective: To examine the association between benzodiazepine use and the risk of dementia. Design, setting, and participants: We conducted a retrospective cohort study, using a nationwide healthcare database of South Korea (2002-2016). The participants included new users of benzodiazepines aged ≥50 years, with no prior prescription record of benzodiazepines or a history of dementia within the previous 5 years (2002-2006). Methods: Outcome was defined as an incident dementia with specified algorithms using diagnosis and prescription records, with the application of a 5-year lag-time following the index date during which outcomes were censored. We used a multivariable Cox proportional hazard model to estimate hazard ratio (HR) and the 95% confidence interval (CI). Comorbidities and comedications were treated as time-varying covariates in 90-day windows, and an active comparator was used to reduce potential bias from confounding by indication. Active comparators were defined as new-users of antidepressants. Results: Our final participants included 616,256 patients, after propensity score estimation and matching on a 1:1 ratio. We observed a 23% increase in the risk of dementia in benzodiazepine users, compared with that in nonusers, over a mean follow-up period of 5.5 years (HR 1.23, 95% CI 1.14-1.32). A consistent finding was observed when the lag-time duration was extended to 7 years, revealing a close to null association (HR 1.17, 95% CI 1.04-1.30). When new-users of antidepressants were used as the active comparator, no increase in the risk of dementia with benzodiazepines was observed over 7 years (HR 1.01, 95% CI 0.81-1.27). Conclusions and implications: A significant association was observed between benzodiazepine use and the risk of dementia, compared with nonusers. However, a null or negative association was observed with the use of the active comparator, suggesting the absence of a causal association between dementia and benzodiazepine use.
Full Text
https://www.sciencedirect.com/science/article/pii/S1525861019306334
DOI
10.1016/j.jamda.2019.08.017
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Psychiatry (정신과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Woo Jung(김우정) ORCID logo https://orcid.org/0000-0002-4963-4819
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/179020
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