Use of self-controlled analytical techniques to assess the association between use of prescription medications and the risk of motor vehicle crashes

Jack E. Gibson, Richard B. Hubbard, Christopher J.P. Smith, Laila J. Tata, John R. Britton, Andrew W. Fogarty

Research output: Journal PublicationArticlepeer-review

91 Citations (Scopus)

Abstract

Case-crossover and case-series analyses are 2 epidemiologic approaches that can be used to evaluate the association of exposures with acute events. Using a primary care database from the United Kingdom and these 2 statistical approaches, the authors investigated the impact of using benzodiazepines, nonbenzodiazepine hypnotics, beta-blockers, selective serotonin reuptake inhibitors, tricyclic antidepressants, opioids, and antihistamines on the risk of motor vehicle crashes in 1986-2004. For 49,821 individuals aged 18-74 years, involvement in a motor vehicle crash was documented. The outcome of the case-crossover analyses varied according to the choice of control period, so the case-series approach was preferred. The first 4 weeks of treatment with a combined acetaminophen and opioid preparation was associated with an increased risk of motor vehicle crash (incidence rate ratio = 2.06, 99% confidence interval: 1.84, 2.32), as was use of an opioid alone (incidence rate ratio = 1.70, 99% confidence interval: 1.39, 2.08) and benzodiazepines (incidence rate ratio = 1.94, 99% confidence interval: 1.62, 2.32). Use of selective serotonin reuptake inhibitors, nonbenzodiazepine hypnotics, and antihistamines for more than 4 weeks was associated with motor vehicle crash, but shorter term use was not. The results obtained are broadly consistent with those from well-designed case-control studies and demonstrate how case-only techniques optimize the use of routinely collected data for epidemiologic studies.

Original languageEnglish
Pages (from-to)761-768
Number of pages8
JournalAmerican Journal of Epidemiology
Volume169
Issue number6
DOIs
Publication statusPublished - Mar 2009
Externally publishedYes

Keywords

  • Accidents, traffic
  • Analgesics, opioid
  • Antidepressive agents, tricyclic
  • Benzodiazepines
  • Data interpretation, statistical
  • Hypnotics and sedatives

ASJC Scopus subject areas

  • Epidemiology

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