title: Road traffic crash risk associated with benzodiazepine and z-hypnotic use after implementation of a colour-graded pictogram: a responsibility study.
abstract: To assess potential change in medicine exposure and association with the risk of road traffic crash across a time period that started before the implementation of a grading system warning of the effect of medicine on driving performance.
  
  
  
  Data from three French national databases were extracted and matched: the national health care insurance database, police reports and the national police database of injurious crashes. Drivers involved in such crashes in France, from July 2005 to December 2011 and identified by their national identifier, were included. Association with the risk of crash was estimated using a case-control analysis comparing benzodiazepine and z-hypnotic use among drivers responsible or not responsible for the crash.
  
  
  
  Totals of 69 353 responsible and 73 410 non-responsible drivers involved in an injurious crash were included. Exposure to benzodiazepine anxiolytics was associated with an increased risk of being responsible for a road traffic crash during the pre-intervention period (OR = 1.42 [1.24-1.62]). The association disappeared in the post-intervention period, but became significant again thereafter. The risk of being responsible for a crash increased in users of z-hypnotics across the study period.
  
  
  
  Our results question the efficacy of the measures implemented to promote awareness about the effects of medicines on driving abilities. Prevention policies relating to the general driving population, but also to healthcare professionals, should be reviewed.
authors.affiliation: Centre INSERM U1219-Epidemiologie-Biostatistique, Université de Bordeaux, ISPED, F-33000, Bordeaux, France.|INSERM, IETO team, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000, Bordeaux, France.
authors.forename: Ludivine
authors.initials: L
authors.lastname: Orriols
authors.affiliation: Centre INSERM U1219-Epidemiologie-Biostatistique, Université de Bordeaux, ISPED, F-33000, Bordeaux, France.|INSERM, IETO team, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000, Bordeaux, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Luxcey
authors.affiliation: Centre INSERM U1219-Epidemiologie-Biostatistique, Université de Bordeaux, ISPED, F-33000, Bordeaux, France.|INSERM, IETO team, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000, Bordeaux, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Contrand
authors.affiliation: Université de Lyon, F-69000, Lyon, France.|IFSTTAR, UMR T 9405, UMRESTTE, F-69500, Bron, France.|UMRESTTE, Université Lyon 1, F-69000, Lyon, France.
authors.forename: Blandine
authors.initials: B
authors.lastname: Gadegbeku
authors.affiliation: External expert of the French National Agency for Medicines and Health Products Safety (ANSM), France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Delorme
authors.affiliation: Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), 93385, Saint-Denis Cedex, France.
authors.forename: Aurore
authors.initials: A
authors.lastname: Tricotel
authors.affiliation: INSERM U1219, Université de Bordeaux, CIC1410, Bordeaux, France.
authors.forename: Nicholas
authors.identifier: 0000-0003-1212-2817
authors.initials: N
authors.lastname: Moore
authors.affiliation: Centre INSERM U1219-Epidemiologie-Biostatistique, Université de Bordeaux, ISPED, F-33000, Bordeaux, France.|INSERM, IETO team, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000, Bordeaux, France.|Service d'information médicale, CHU de Bordeaux, Pôle de santé publique, Bordeaux, France.
authors.forename: Louis-Rachid
authors.initials: LR
authors.lastname: Salmi
authors.affiliation: Centre INSERM U1219-Epidemiologie-Biostatistique, Université de Bordeaux, ISPED, F-33000, Bordeaux, France.|INSERM, IETO team, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000, Bordeaux, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lagarde
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control / Q000706:statistics & numerical data; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001334:Automobile Driving / Q000706:statistics & numerical data*; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects*; D016208:Databases, Factual; D004348:Drug Labeling / Q000379:methods*; D005602:France; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D012306:Risk; D012309:Risk-Taking; D012941:Social Responsibility
chemical_list: D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines
keywords: anxiolytics; benzodiazepines; hypnotics; pictogram; road traffic crash