title: Long-term use of zolpidem increases the risk of major injury: a population-based cohort study.
abstract: OBJECTIVE
  To estimate the risk of head injury or fracture requiring hospitalization in patients treated with zolpidem.
  
  
  METHODS
  We identified 8188 patients 18 years and older who had received a first prescription for zolpidem between January 1, 2000, and December 31, 2009, and compared them with 32,752 age- and sex-matched patients who had not used sedative-hypnotic agents. Both cohorts were followed up for at least 1 year or until hospitalization for head injury or fracture (major injury). Hazard ratios (HRs) and 95% CIs were calculated by comparing the incidence of major injury requiring hospitalization between the zolpidem user and comparison cohorts, including age groups 18 to 54 and 55 years or more, using a Cox proportional hazards regression analysis.
  
  
  RESULTS
  The adjusted HR for major injury in zolpidem users was 1.67 (95% CI, 1.19-2.34). The adjusted HR for major injury in zolpidem users in the younger cohort (aged 18-54 years) was 1.70 (95% CI, 1.15-2.51) and in the older cohort (aged ≥55 years) was 1.57 (95% CI, 0.78-3.13). The adjusted HR for major injury in zolpidem users increased when the zolpidem dosage increased (HR, 2.04; 95% CI, 1.32-3.13 for 71-800 mg/y; HR, 4.37; 95% CI, 2.12-9.01 for 801-1600 mg/y; and HR, 4.74; 95% CI, 2.38-9.42 for >1600 mg/y).
  
  
  CONCLUSIONS
  The long-term use of zolpidem is associated with a significantly greater risk of head injury or fracture requiring hospitalization than in patients who do not use sedative-hypnotic agents (P<.001), particularly in the younger (aged 18-54 years) patients.
authors.affiliation: Department of Family Medicine, China Medical University & Hospital, Taichung, Taiwan.
authors.forename: Ming-May
authors.initials: MM
authors.lastname: Lai
authors.affiliation: Department of Family Medicine, China Medical University & Hospital, Taichung, Taiwan; Institute of Health Care Administration, College of Public Health, China Medical University & Hospital, Taichung, Taiwan; Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan.
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Management Office for Health Data, China Medical University & Hospital, Taichung, Taiwan.
authors.forename: Che-Chen
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Department of Family Medicine, China Medical University & Hospital, Taichung, Taiwan.
authors.forename: Chiu-Shong
authors.initials: CS
authors.lastname: Liu
authors.affiliation: Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan; Graduate Institute of Biostatistics & Chinese Medicine Science and Biostatistics Center, China Medical University, Taichung, Taiwan.
authors.forename: Tsai-Chung
authors.initials: TC
authors.lastname: Li
authors.affiliation: Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. Electronic address: d10040@mail.cmuh.org.tw.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011725:Pyridines / Q000009:adverse effects* / Q000627:therapeutic use; D013997:Time Factors; D055815:Young Adult; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem