TABLE 3.
Secondary and Sensitivity Analyses: Benzodiazepine and SSRI (Referent) Initiators and Rate of Fractures (Primary Definition: Upper and Lower Limb)
| Crude | Adjusteda | |||||
|---|---|---|---|---|---|---|
| Benzodiazepine Users | SSRI Users | IRR (95% CI) | IRD per 1000 PYs | IRR (95% CI) | IRD per 1000 PYs | |
| Fracture Rate per 1000 PYs | Fracture Rate per 1000 PYs | |||||
| Children (6–17 y), % of cohort | 33.1 | 25.1 | 1.32 (0.95–1.83) | 8.0 | 1.53 (0.94–2.50) | 13.4 |
| SIPTW estimate | — | — | — | — | 1.36 (0.84–2.19) | 9.0 |
| Maximum of 30 d follow-up | 35.3 | 25.7 | 1.37 (0.94–2.00) | 9.6 | 1.54 (0.88–2.69) | 14.0 |
| Intention-to-treat analysis | 23.9 | 24.4 | 0.98 (0.77–1.25) | −0.5 | 1.16 (0.81–1.66) | 3.9 |
| Treatment duration grace period | ||||||
| 10 d | 36.0 | 25.0 | 1.44 (1.00–2.08) | 11.0 | 1.83 (1.07–3.14) | 20.5 |
| 30 d | 30.0 | 24.9 | 1.21 (0.89–1.65) | 5.2 | 1.35 (0.84–2.15) | 8.5 |
| Initial d supply 3+ d (98%) | 30.5 | 25.1 | 1.21 (0.85–1.74) | 5.4 | 1.34 (0.79–2.27) | 8.4 |
| Fracture outcomes by ICD-9-CM only (81%) | 31.3 | 26.0 | 1.20 (0.84–1.72) | 5.3 | 1.32 (0.84–2.89) | 8.1 |
| No previous injury (67%) | 21.1 | 19.7 | 1.07 (0.64–1.80) | 1.4 | 1.58 (0.79–3.15) | 11.3 |
| No baseline antidepressant use (95%) | 33.3 | 25.0 | 1.33 (0.94–1.89) | 8.3 | 1.43 (0.83–2.44) | 10.6 |
| No psychotropic use (78%) | 27.9 | 24.6 | 1.14 (0.75–1.71) | 3.3 | 1.44 (0.69–3.00) | 10.4 |
| No depression diagnosisb (70%) | 34.0 | 27.0 | 1.26 (0.88–1.80) | 7.0 | 1.44 (0.83–2.50) | 11.6 |
| Stratification by ADHD diagnosis | ||||||
| ADHD (21%) | 58.8 | 27.2 | 2.16 (1.14–4.11) | 31.6 | 2.00 (0.86–4.66) | 27.2 |
| No ADHD (79%) | 28.6 | 24.5 | 1.17 (0.80–1.71) | 4.1 | 1.56 (0.84–2.89) | 13.6 |
| Stratification by psychiatric comorbidity | ||||||
| Psychiatric comorbidity (58%) | 39.7 | 25.6 | 1.55 (0.97–2.50) | 14.2 | 1.89 (1.03–3.46) | 22.8 |
| No comorbidity (42%) | 28.8 | 24.4 | 1.18 (0.75–1.86) | 4.4 | 0.86 (0.45–1.66) | −3.2 |
| Stratification by sex | ||||||
| Male (38%) | 45.0 | 33.4 | 1.35 (0.86–2.12) | 11.7 | 1.40 (0.76–2.58) | 13.5 |
| Female (62%) | 25.6 | 20.0 | 1.28 (0.79–2.09) | 5.5 | 1.34 (0.66–2.69) | 6.5 |
| Young adults (18–24 y), % of cohort | 8.7 | 8.9 | 0.98 (0.72–1.33) | −0.2 | 0.85 (0.57–1.27) | −1.3 |
| SIPTW estimate | — | — | — | — | 0.90 (0.61–1.35) | −0.9 |
| Maximum of 30 d follow-up | 7.9 | 8.9 | 0.88 (0.59–1.32) | −1.0 | 0.79 (0.47–1.33) | −2.0 |
| Intention-to-treat analysis | 8.6 | 8.7 | 0.99 (0.79–1.23) | −0.1 | 0.83 (0.64–1.08) | −1.5 |
| Treatment duration grace period | ||||||
| 10 d | 8.9 | 8.6 | 1.03 (0.73–1.46) | 0.3 | 0.97 (0.62–1.52) | −0.3 |
| 30 d | 8.9 | 8.9 | 1.00 (0.76–1.32) | 0.0 | 0.84 (0.59–1.20) | −1.4 |
| Initial d supply 3+ d (98%) | 8.6 | 8.8 | 0.98 (0.72–1.34) | −0.2 | 0.86 (0.57–1.28) | −1.3 |
| Fracture outcomes by ICD-9-CM only (80%) | 8.0 | 9.3 | 0.87 (0.61–1.22) | −1.2 | 0.68 (0.45–1.03) | −2.9 |
| No previous injury (72%) | 6.0 | 7.1 | 0.85 (0.55–1.31) | −1.0 | 0.68 (0.41–1.12) | −2.3 |
| No baseline antidepressant use (92%) | 8.8 | 9.1 | 0.98 (0.71–1.35) | −0.2 | 0.85 (0.55–1.31) | −1.4 |
| No psychotropic use (82%) | 8.2 | 8.7 | 0.93 (0.65–1.34) | −0.6 | 0.75 (0.48–1.18) | −2.3 |
| No depression diagnosisb (76%) | 9.0 | 9.0 | 1.00 (0.72–1.39) | 0.0 | 0.85 (0.58–1.26) | −1.3 |
| No ADHD diagnosisb (90%) | 8.5 | 8.6 | 1.00 (0.72–1.38) | 0.0 | 0.83 (0.56–1.24) | −1.4 |
| Stratification by psychiatric comorbidity | ||||||
| Psychiatric comorbidity (39%) | 8.8 | 9.0 | 0.98 (0.58–1.65) | −0.2 | 0.98 (0.49–1.95) | −0.2 |
| No comorbidity (61%) | 8.6 | 8.8 | 0.98 (0.67–1.44) | −0.2 | 0.85 (0.55–1.32) | −1.2 |
| Stratification by sex | ||||||
| Male (33%) | 10.8 | 12.2 | 0.89 (0.56–1.40) | −1.4 | 0.62 (0.37–1.06) | −4.6 |
| Female (67%) | 7.4 | 7.3 | 1.02 (0.68–1.55) | 0.2 | 1.04 (0.61–1.77) | 0.3 |
—, not applicable.
a
Adjusted results: IPTW applied in trimmed cohort (except when noted for SIPTW results).
b
Results from strata with <10 fracture events in a treatment group are not displayed.