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American Journal of Epidemiology Advance Access originally published online on January 30, 2009
American Journal of Epidemiology 2009 169(6):761-768; doi:10.1093/aje/kwn364
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

PRACTICE OF EPIDEMIOLOGY

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 and Andrew W. Fogarty

Correspondence to Dr. Jack E. Gibson, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom (e-mail: jack.gibson{at}nottingham.ac.uk).

Received for publication May 14, 2008. Accepted for publication October 14, 2008.

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.

accidents, traffic; analgesics, opioid; antidepressive agents, tricyclic; benzodiazepines; data interpretation, statistical; hypnotics and sedatives

Abbreviations: CI, confidence interval; IRR, incidence rate ratio; SSRI, selective serotonin reuptake inhibitor; THIN, The Health Improvement Network


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