Nonbenzodiazepine hypnotics and police-reported motor vehicle crash risk among older adults: a sequential target trial emulation.
Andrew R Zullo, Marzan A Khan, Melissa R Pfeiffer, Seth A Margolis, Brian R Ott, Allison E Curry, Thomas A Bayer, Melissa R Riester, Nina R Joyce
Author Information
Andrew R Zullo: Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island 02912, United States. ORCID
Marzan A Khan: Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island 02912, United States. ORCID
Melissa R Pfeiffer: Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, United States. ORCID
Seth A Margolis: Rhode Island Hospital, Providence, Rhode Island 02903, United States. ORCID
Brian R Ott: Department of Neurology, Brown University, Providence, Rhode Island 02912, United States. ORCID
Allison E Curry: Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, United States. ORCID
Thomas A Bayer: Center of Innovation in Long-term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island 02908, United States. ORCID
Melissa R Riester: Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island 02912, United States. ORCID
Nina R Joyce: Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island 02912, United States. ORCID
Nonbenzodiazepine hypnotics ("Z-drugs") are prescribed for insomnia but might increase the risk of motor vehicle crash (MVC) among older adults through prolonged drowsiness and delayed reaction times. We estimated the effect of initiating Z-drug treatment on the 12-week risk of MVC in a sequential target trial emulation. After linking New Jersey driver licensing and police-reported MVC data to Medicare claims, we emulated a new target trial each week (July 1, 2007, to October 7, 2017) in which Medicare fee-for-service beneficiaries were classified as Z-drug-treated or untreated at baseline and followed for an MVC. We used inverse probability of treatment and censoring-weighted pooled logistic regression models to estimate risk ratios (RRs) and risk differences with 95% bootstrap confidence limits (CLs). There were 257���554 person-trials, of which 103���371 were Z-drug-treated and 154���183 untreated, giving rise to 976 and 1249 MVCs, respectively. The intention-to-treat RR was 1.06 (95% CL, 0.95-1.16). For the per-protocol estimand, there were 800 MVCs and 1241 MVCs among treated and untreated person-trials, respectively, suggesting a reduced MVC risk (RR, 0.83; 95% CL, 0.74-0.92) with sustained Z-drug treatment. Z-drugs should be prescribed to older patients judiciously but not withheld entirely over concerns about MVC risk. This article is part of a Special Collection on Pharmacoepidemiology.
