Dataset Information

Benzodiazepine Use in Older Adults in the United States, Ontario, and Australia from 2010 to 2016.

ABSTRACT: OBJECTIVES:To detail annual trends in benzodiazepine incidence and prevalence in older adults between 2010 and 2016 in three countries. DESIGN:Observational multicountry cohort study with harmonized study protocol. SETTING:The United States (veteran population); Ontario, Canada; and Australia. PARTICIPANTS:All people aged 65 and older (8,270,000 people). MEASUREMENTS:Annual incidence and prevalence of benzodiazepine use stratified according to age group (65-74, 75-84, ?85) and sex. We performed multiple regression analyses to assess whether rates of incident and prevalent use changed significantly over time. RESULTS:Over the study period, we observed a significant decrease in incident benzodiazepine use in the United States (2.6% to 1.7%) and Ontario (6.0% to 4.4%) but not Australia (7.0% to 6.7%). We found significant declines in prevalent use in all countries (United States: 9.2% to 7.3%; Ontario: 18.2% to 13.4%; Australia: 20.2% to 16.8%). Although incidence and prevalence increased with age in Ontario and Australia, they decreased with age in the United States. Incidence and prevalence were higher in women in all countries. CONCLUSION:Consistent with other international studies, there have been small but significant reductions in the incidence and prevalence of benzodiazepine use in older adults in all three countries, with the exception of incidence in Australia, although use remains inappropriately high-particularly in those aged 85 and older-which warrants further attention from clinicians and policy-makers.

SUBMITTER: Brett J

PROVIDER: S-EPMC6087688 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Benzodiazepine Use in Older Adults in the United States, Ontario, and Australia from 2010 to 2016.

Brett Jonathan J Maust Donovan T DT Bouck Zach Z Ignacio Rosalinda V RV Mecredy Graham G Kerr Eve A EA Bhatia Sacha S Elshaug Adam G AG Pearson Sallie A SA

Journal of the American Geriatrics Society 20180212 6

<h4>Objectives</h4>To detail annual trends in benzodiazepine incidence and prevalence in older adults between 2010 and 2016 in three countries.<h4>Design</h4>Observational multicountry cohort study with harmonized study protocol.<h4>Setting</h4>The United States (veteran population); Ontario, Canada; and Australia.<h4>Participants</h4>All people aged 65 and older (8,270,000 people).<h4>Measurements</h4>Annual incidence and prevalence of benzodiazepine use stratified according to age group (65-74 ...[more]

PMID: 29430639

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Project description:BackgroundGuidelines recommend most benzodiazepine (BZD) treatment be short-term, though chronic BZD use is increasing.ObjectiveDetermine the rate of BZD discontinuation among chronic users and identify patient- and provider-level factors associated with discontinuation.Design, setting, and participantsA retrospective cohort study using nationwide insurance claims data from 2014 to 2016 of US adults ≥ 18 years old with chronic BZD use (i.e., > 120 days) during the baseline year.Main outcomes and measuresThe primary outcome was BZD discontinuation among chronic users after 1 year of follow-up. A series of multilevel logistic regression models examined the association of BZD discontinuation with patient and provider characteristics. Covariates included patient sociodemographics, medical and psychiatric comorbidity, co-prescribed opioids and other psychotropics, and characteristics of the prescribed BZD.Key resultsOf 141,008 chronic BZD users, 13.4% discontinued use after 1 year. Females had lower odds of discontinuation (AOR 0.83, 99% CI 0.79-0.87), while African-American patients had higher odds (AOR 1.12, 99% CI 1.03-1.22). Those prescribed a high-potency BZD had lower odds of discontinuation (AOR 0.51, 99% CI 0.47-0.54), as did those prescribed an opioid (AOR 0.94, 99% CI 0.89-0.99). After adjusting for patient- and provider-level factors, differences between providers accounted for 5.8% of variation in BZD discontinuation (p < 0.001). The median odds ratio for provider was 1.54, an association with discontinuation larger than almost all patient-level clinical variables.ConclusionsA small minority of patients prescribed chronic BZD in a given year are no longer prescribed BZDs 1 year later. There is significant variation in the likelihood of discontinuation accounted for by non-clinical factors such as race, geography, and a patient's provider, which had a stronger association with the odds of discontinuation than almost every other patient-level variable. Provider-facing elements of interventions to reduce BZD prescribing may be critical.

Project description:ImportanceBenzodiazepines have been prescribed for short periods to patients with depression who are beginning antidepressant therapy to improve depressive symptoms more quickly, mitigate concomitant anxiety, and improve antidepressant treatment continuation. However, benzodiazepine therapy is associated with risks, including dependency, which may take only a few weeks to develop.ObjectivesTo examine trends in simultaneous benzodiazepine and antidepressant new use among adults with depression initiating an antidepressant, assess antidepressant treatment length by simultaneous new use status, estimate subsequent long-term benzodiazepine use in those with simultaneous antidepressant and benzodiazepine new use, and identify determinants of simultaneous new use and long-term benzodiazepine use.Design, setting, and participantsThis cohort study using a US commercial claims database included commercially insured adults (aged 18-64 years) from January 1, 2001, through December 31, 2014, with a recent depression diagnosis who began antidepressant therapy but had not used antidepressants or benzodiazepines in the prior year.ExposuresSimultaneous new use, defined as a new benzodiazepine prescription dispensed on the same day as a new antidepressant prescription.Main outcomes and measuresThe proportion of antidepressant initiators with simultaneous new use and continuing antidepressant treatment for 6 months and the proportion of simultaneous new users receiving long-term (6-months) benzodiazepine therapy.ResultsOf the 765 130 adults (median age, 39 years; interquartile range, 29-49 years; 507 451 women [66.3%]) who initiated antidepressant treatment, 81 020 (10.6%) also initiated benzodiazepine treatment. The mean annual increase in the proportion simultaneously starting use of both agents from 2001 to 2014 was 0.49% (95% CI, 0.47%-0.51%), increasing from 6.1% (95% CI, 5.5%-6.6%) in 2001 to 12.5% (95% CI, 12.3%-12.7%) in 2012 and stabilizing through 2014 (11.3%; 95% CI, 11.1%-11.5%). Similar findings were apparent by age group and physician type. Antidepressant treatment length was similar in simultaneous new users and non-simultaneous new users. Among simultaneous new users, 12.3% (95% CI, 12.0%-12.5%) exhibited long-term benzodiazepine use (64.0% discontinued taking benzodiazepines after the initial fill). Determinants of long-term benzodiazepine use after simultaneous new use were longer initial benzodiazepine days' supply, first prescription for a long-acting benzodiazepine, and recent prescription opioid fills.Conclusions and relevanceOne-tenth of antidepressant initiators with depression simultaneously initiated benzodiazepine therapy. No meaningful difference in antidepressant treatment at 6 months was observed by simultaneous new use status. Because of the risks associated with benzodiazepines, simultaneous new use at antidepressant initiation and the benzodiazepine regimen itself require careful consideration.

Project description:Background/objectivesWith an aging population suffering from increased prevalence of chronic conditions in the United States (U.S.), a large portion of these patients are on multiple medications. High-risk medications can increase the risk for drug-drug interactions and medication nonadherence. This study aims to describe the prevalence of polypharmacy and high-risk medication prescribing in U.S. physician offices.MethodsThis was a cross-sectional study of the Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey from 2009 to 2016. All patients over 65 years old were included. Polypharmacy was categorized as no polypharmacy (< 2 medications), minor polypharmacy (2-3 medications), moderate polypharmacy (4-5 medications), and major polypharmacy (>5 medications). Medications were further categorized into high-risk medication categories (anticholinergics, cardiovascular agents, central nervous system (CNS) medications, pain medications, and other). Comparisons between the degrees of polypharmacy were performed utilizing chi-square or Wilcoxon rank-sum tests with JMP Pro 14® (SAS Institute, Cary, NC).ResultsOver 2 billion patient visits were included. Overall, Polypharmacy was common (65.1%): minor polypharmacy (16.2%), moderate polypharmacy (12.1%), and major polypharmacy (36.8%). Patients with major polypharmacy were older compared to those with moderate or minor polypharmacy (75 vs. 73 years, respectively) and were most frequently prescribed pain medications (477.3 per 1,000 total visits). NSAIDs were the most frequently prescribed, with 232.4 per 1,000 total visits resulting in one high-risk NSAID prescription, while 21.9 per 1,000 total visits resulted in two or more high-risk NSAIDs.ConclusionMost patients over 65 years experienced some degree of polypharmacy, with many experiencing major polypharmacy. This indicates an increased need for expanded pharmacist roles through medication therapy management and safety monitoring in this patient population.

Dataset Information

Benzodiazepine Use in Older Adults in the United States, Ontario, and Australia from 2010 to 2016.

Publications

Benzodiazepine Use in Older Adults in the United States, Ontario, and Australia from 2010 to 2016.

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