Trajectories in hypnotic use and approaching death: a register linked case–control study

Publication date: Available online 7 March 2018
Source:Sleep Medicine
Author(s): Erkki Kronholm, Pekka Jousilahti, Tiina Laatikainen, Tea Lallukka, Markku Peltonen, Johanna Seppänen, Lauri Virta
PurposeWhether the association between hypnotic and increased mortality risk is created by causation or confounding, has been long debated. We examined further the possibility of confounding by indication with a comprehensive approach.MethodsThe National FINRISK Study cohorts of 1997, 2002, and 2007 (25,436 participants aged 25–74) were followed up until July 2012. There were 1,822 deaths, and at least one gender, baseline age and cohort matched 'control' was found for 1,728 'cases' yielding a final analytical sample of 3,955 individuals. An index age, equivalent to the age at death of their respective cases' was set for each control. Hypnotic drug purchases were followed from the Finnish nationwide register during a 36-month run-up period before the date of death/index date. The prevalence and incidence of hypnotic purchases were compared between cases and matched controls. In addition, latent developmental trajectories of purchases were modelled and their relations with specific and all-cause death risks were analysed.ResultsAn increasing difference between cases and controls was observed as regards the use of hypnotic drugs. During the last 30 months before the date of death/index date, the rate ratio of incident purchases between cases and controls was 2.37 (95% CL, 1.79–3.12) among older and 3.61 (95% CL, 2.37–5.89) among younger individuals. The developmental trajectories of hypnotic drug purchases were differently and by interpretation plausibly associated with specific mortality risks.ConclusionsIn most cases the association between hypnotics and mortality risk is created by symptomatic treatment when death is approaching.



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