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Risks of Long-Term Benzodiazepine Use Among Patients with Chronic Obstructive Pulmonary Disease and Posttraumatic Stress Disorder
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A2515 - Risks of Long-Term Benzodiazepine Use Among Patients with Chronic Obstructive Pulmonary Disease and Posttraumatic Stress Disorder
Author Block: L. M. Donovan1, C. A. Malte2, L. J. Spece1, M. F. Griffith1, L. C. Feemster2, R. A. Engelberg1, D. H. Au2, E. J. Hawkins2; 1University of Washington, Seattle, WA, United States, 2VA Puget Sound Health Care System, Seattle, WA, United States.
Introduction: Benzodiazepine use is linked to mortality and respiratory failure in patients with chronic obstructive pulmonary disease (COPD), a finding possibly confounded by frequent use of benzodiazepines for end-stage dyspnea. To help control for such confounding, we assessed the mortality risk of benzodiazepines among a sample of patients with COPD and comorbid posttraumatic stress disorder (PTSD). Benzodiazepines are used in 30% of Veterans with PTSD for anxiety and insomnia symptoms.
Methods: Using nationwide administrative data from the Veterans Health Administration, we included all patients with diagnostic codes for COPD and PTSD over the age of 40 who were not enrolled in hospice. We defined long-term benzodiazepine use as 90 or more days’ supply of benzodiazepines in the 180 days prior to an index date when entry criteria were met. We propensity-matched patients with long-term use to those with no benzodiazepine use on 41 variables including demographics, medical and mental health comorbidities, and markers of COPD and PTSD disease severity. We evaluated mortality risk using Cox models, and independent risk of death from lung disease, suicide, and overdose using Fine-Gray regression models to account for competing risks. We estimated incidence of COPD exacerbations, medical and mental health admissions using separate negative binomial regression models.
Results: Among 44,555 Veterans with COPD and PTSD, 10,536 (23.6%) received benzodiazepines long-term. We matched 9,765 of patients with long-term use to an equal number of those with non-use. At 2 years, we observed no difference in risk of death between those prescribed benzodiazepines long-term and non-users (HR 1.10, 95%CI 0.99-1.22). Accounting for competing risks of death from other causes, there were no differences in death due to obstructive lung disease (HR 1.18, 95%CI 0.95-1.45) or accidental overdose (HR 1.03, 95%CI 0.58-1.81), but risk of suicide was substantially greater among those with long-term use (HR 5.29, 95% CI 1.96-14.33). COPD exacerbations (IRR 1.04, 95% CI 0.98-1.10) and medical hospitalizations (IRR 0.99, 95%CI 0.93-1.05) were not elevated, but the incidence of psychiatric admissions among patients with long-term benzodiazepine prescriptions was significantly higher than non-users (IRR 1.22, 95%CI 1.06-1.40).
Conclusions: In a population of COPD patients enriched in non-respiratory symptoms that often prompt benzodiazepine use, all-cause mortality was not associated with long-term use. These results suggest previous estimates of risk may have been confounded by indication. Increased risk of suicide and psychiatric admissions suggest the need to exercise caution with benzodiazepine use in this population.
Author Block: L. M. Donovan1, C. A. Malte2, L. J. Spece1, M. F. Griffith1, L. C. Feemster2, R. A. Engelberg1, D. H. Au2, E. J. Hawkins2; 1University of Washington, Seattle, WA, United States, 2VA Puget Sound Health Care System, Seattle, WA, United States.
Introduction: Benzodiazepine use is linked to mortality and respiratory failure in patients with chronic obstructive pulmonary disease (COPD), a finding possibly confounded by frequent use of benzodiazepines for end-stage dyspnea. To help control for such confounding, we assessed the mortality risk of benzodiazepines among a sample of patients with COPD and comorbid posttraumatic stress disorder (PTSD). Benzodiazepines are used in 30% of Veterans with PTSD for anxiety and insomnia symptoms.
Methods: Using nationwide administrative data from the Veterans Health Administration, we included all patients with diagnostic codes for COPD and PTSD over the age of 40 who were not enrolled in hospice. We defined long-term benzodiazepine use as 90 or more days’ supply of benzodiazepines in the 180 days prior to an index date when entry criteria were met. We propensity-matched patients with long-term use to those with no benzodiazepine use on 41 variables including demographics, medical and mental health comorbidities, and markers of COPD and PTSD disease severity. We evaluated mortality risk using Cox models, and independent risk of death from lung disease, suicide, and overdose using Fine-Gray regression models to account for competing risks. We estimated incidence of COPD exacerbations, medical and mental health admissions using separate negative binomial regression models.
Results: Among 44,555 Veterans with COPD and PTSD, 10,536 (23.6%) received benzodiazepines long-term. We matched 9,765 of patients with long-term use to an equal number of those with non-use. At 2 years, we observed no difference in risk of death between those prescribed benzodiazepines long-term and non-users (HR 1.10, 95%CI 0.99-1.22). Accounting for competing risks of death from other causes, there were no differences in death due to obstructive lung disease (HR 1.18, 95%CI 0.95-1.45) or accidental overdose (HR 1.03, 95%CI 0.58-1.81), but risk of suicide was substantially greater among those with long-term use (HR 5.29, 95% CI 1.96-14.33). COPD exacerbations (IRR 1.04, 95% CI 0.98-1.10) and medical hospitalizations (IRR 0.99, 95%CI 0.93-1.05) were not elevated, but the incidence of psychiatric admissions among patients with long-term benzodiazepine prescriptions was significantly higher than non-users (IRR 1.22, 95%CI 1.06-1.40).
Conclusions: In a population of COPD patients enriched in non-respiratory symptoms that often prompt benzodiazepine use, all-cause mortality was not associated with long-term use. These results suggest previous estimates of risk may have been confounded by indication. Increased risk of suicide and psychiatric admissions suggest the need to exercise caution with benzodiazepine use in this population.
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