title: The Use of Hypnotics and Mortality--A Population-Based Retrospective Cohort Study.
abstract: BACKGROUND
  Sleep disorders, especially chronic insomnia, have become major health problem worldwide and, as a result, the use of hypnotics is steadily increasing. However, few studies with a large sample size and long-term observation have been conducted to investigate the relationship between specific hypnotics and mortality.
  
  
  METHODS
  We conducted this retrospective cohort study using data from the National Health Insurance Research Database in Taiwan. Information from claims data including basic characteristics, the use of hypnotics, and survival from 2000 to 2009 for 1,320,322 individuals were included. The use of hypnotics was divided into groups using the defined daily dose and the cumulative length of use. Hazard ratios (HRs) were calculated from a Cox proportional hazards model, with two different matching techniques to examine the associations.
  
  
  RESULTS
  Compared to the non-users, both users of benzodiazepines (HR = 1.81; 95% confidence interval [CI] = 1.78-1.85) and mixed users (HR = 1.44; 95% CI = 1.42-1.47) had a higher risk of death, whereas the users of other non-benzodiazepines users showed no differences. Zolpidem users (HR = 0.73; 95% CI = 0.71-0.75) exhibited a lower risk of mortality in the adjusted models. This pattern remained similar in both matching techniques. Secondary analysis indicated that zolpidem users had a reduced risk of major cause-specific mortality except cancer, and that this protective effect was dose-responsive, with those using for more than 1 year having the lowest risk.
  
  
  CONCLUSIONS
  The effects of different types of hypnotics on mortality were diverse in this large cohort with long-term follow-up based on representative claims data in Taiwan. The use of zolpidem was associated with a reduced risk of mortality.
authors.affiliation: Institute of Hospital & Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Tzuo-Yun
authors.initials: TY
authors.lastname: Lan
authors.affiliation: Institute of Hospital & Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ya-Fang
authors.initials: YF
authors.lastname: Zeng
authors.affiliation: Institute of Hospital & Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Gau-Jun
authors.initials: GJ
authors.lastname: Tang
authors.affiliation: Department of Public Health, Tzu Chi University, Hualien, Taiwan.
authors.forename: Hui-Chuan
authors.initials: HC
authors.lastname: Kao
authors.affiliation: Min-Sheng General Hospital, Taoyuan, Taiwan.
authors.forename: Hsien-Jane
authors.initials: HJ
authors.lastname: Chiu
authors.affiliation: Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Tsuo-Hung
authors.initials: TH
authors.lastname: Lan
authors.affiliation: National Health Insurance Administration, Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Hsiao-Feng
authors.initials: HF
authors.lastname: Ho
mesh_terms: D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000401:mortality*; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D001569:Benzodiazepines; D000077334:Zolpidem