title: The Risk of Pneumonia in Older Adults Using Nonbenzodiazepine Hypnotics.
abstract: BACKGROUND
  Previous studies have shown an increased risk of pneumonia with benzodiazepines (BZD) and an increased risk of any infection with non-BZD hypnotics, but no analysis has specifically investigated the risk of pneumonia with non-BZD hypnotic use.
  
  
  OBJECTIVE
  To evaluate the risk of pneumonia associated with non-BZD hypnotic use in the elderly.
  
  
  METHODS
  This was a retrospective case-control study of members aged 65 years and older enrolled in an integrated health care system. Cases were identified as patients aged 65 years and older with a diagnosis of pneumonia from January 2011 to December 2012. Controls were matched in a 4:1 ratio to cases based on age, gender, and active enrollment. Non-BZD hypnotic exposure was evaluated for all cases and controls 1 year before the index date. Proximity of exposure to index date and duration of use were analyzed. Conditional logistic regression adjusted for covariates was performed.
  
  
  RESULTS
  We identified 51,029 cases with pneumonia and matched 188,391 controls without pneumonia. Of the cases with pneumonia, 5.5% (2,790) of cases had exposure to a non-BZD hypnotic, compared with 3.4% (6,345) of controls. Non-BZD hypnotic exposure was associated with an increased risk of pneumonia (OR = 1.14; 95% CI = 1.08-1.20). When exposure was stratified by proximity to index date, only current exposure was associated with an increased risk of pneumonia (OR = 1.27; 95% CI = 1.18-1.36). Short-term exposure was associated with a relatively higher risk of pneumonia (OR = 1.57; 95% CI = 1.39-1.77) compared with long-term use (OR = 1.16; 95% CI = 1.06-1.25).
  
  
  CONCLUSIONS
  Current use of non-BZD hypnotics in older adults is associated with an increased risk of pneumonia. The findings of this study provide additional support for reducing the use of non-BZD hypnotics in older adults and for pursuing safer alternatives for treating insomnia.
  
  
  BACKGROUND
  No outside funding supported this study. At the time of this study, Jung was a PGY2 resident in drug information at Kaiser Permanente Drug Information Services. All authors are employed by Kaiser Permanente and report no other potential financial conflicts of interest. Study concept and design were contributed by Jung, Spence, Lee, and Gibbs. Jung, Spence, and Hui were responsible for data collection, and data interpretation was performed by Jung and Spence, with assistance from Escasa, Lee, and Hui. The manuscript was primarily written by Jung, along with Spence and Escasa, and revised by Spence, Escasa, and Lee, along with the other authors.
authors.affiliation: 1 MedImpact, San Diego, California.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jung
authors.affiliation: 2 Kaiser Permanente Southern California, Downey, California.
authors.forename: Michele M
authors.initials: MM
authors.lastname: Spence
authors.affiliation: 2 Kaiser Permanente Southern California, Downey, California.
authors.forename: Nina M
authors.initials: NM
authors.lastname: Escasa
authors.affiliation: 3 Kaiser Permanente, West Los Angeles Medical Center, Los Angeles, California.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Lee
authors.affiliation: 4 Kaiser Permanente Northern California, Oakland, California.
authors.forename: Rita L
authors.initials: RL
authors.lastname: Hui
authors.affiliation: 5 Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Gibbs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001569:Benzodiazepines; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D011014:Pneumonia / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D011897:Random Allocation; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines