Benzodiazepine Dispensing to Persons With Dementia in France, 2011-2016: A Nationwide Study |
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| Affiliation: | 1. UMR INSERM 1027, INSERM, Toulouse, France;2. Université Toulouse III Paul Sabatier, Toulouse, France;3. Centre Hospitalier Universitaire de Toulouse, Department of Epidemiology and Public Health, Toulouse, France;4. Centre Hospitalier Universitaire de Toulouse, Toulouse, France;5. Centre Hospitalier Universitaire de Toulouse, Department of Pharmacology, Toulouse, France;1. Priority Research Centre for Generational Health and Ageing, The University of Newcastle, Australia;2. Centre for Clinical Epidemiology and Biostatistics, The University of Newcastle, Australia;3. Department of Statistics, Comilla University, Bangladesh;1. Laboratory of Cardiovascular Sciences, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD;2. Department of Public Health and Infectious Disease, University “La Sapienza”, Rome, Italy;3. Loyola University Maryland, Baltimore, MD;4. Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delel Ricerche, Lanusei, Sardinia, Italy;5. Laboratory of Genetics, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD;6. Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delel Ricerche, Cagliari, Italy;7. Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy;1. Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China;2. National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China;3. Center for Study of Healthy Aging and Development Studies, Peking University, Beijing, China;4. Nutritional Epidemiology Lab, Pennsylvania State University, Philadelphia, PA, USA;1. KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada;2. Department of Computer Science, University of Toronto, Toronto, Ontario, Canada;3. Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada;4. Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada;5. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada;6. Center for Mental Health, University Health Network, Toronto, Ontario, Canada;1. Department of Pharmacology, National University of Singapore;2. Memory Aging and Cognition Centre, National University Health System;3. Department of Psychological Medicine, National University Hospital;4. The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China;5. School of Public Health, Zhejiang University |
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| Abstract: | ObjectiveTo study temporal trends of benzodiazepine exposure among incident Alzheimer's disease and related dementia (ADRD) cohorts between 2011 and 2016.DesignRepeated cross-sectional study.Setting and ParticipantsThree nationwide incident ADRD cohorts (community-dwelling and institutionalized subjects) were identified in 2011, 2013, and 2016 through the French health insurance database. Subjects were followed 4 semesters around ADRD identification [Semester −2 (S−2) to Semester 2 (S2)].MeasuresOdds ratios (ORs) for semestrial prevalent exposure, initiation, and adherence to benzodiazepine prescription recommendations (prescription duration <3 months, single reimbursement) were computed using multivariate logistic regressions for each cohort and according to benzodiazepine half-life.ResultsAmong 262,024 community-dwelling subjects, as compared to 2011, overall benzodiazepine prevalence risk decreased slightly immediately after ADRD identification [S1: aOR2013 = 0.93 (0.91-0.95), aOR2016 = 0.95 (0.93-0.97)] and did not differ during S2. Among 72,013 institutionalized subjects, it increased over time [S2: aOR2013 = 1.16 (1.11-1.21), aOR2016 = 1.26 (1.21-1.32)]. Long half-life benzodiazepine prevalence risk decreased in the 4 semesters among recent cohorts, for both populations [S2: community-dwelling: aOR2013 = 0.77 (0.74-0.79), aOR2016 = 0.61 (0.59-0.64); institutionalized: aOR2013 = 0.74 (0.68-0.80), aOR2016 = 0.58 (0.54-0.63)]. Short half-life benzodiazepine prevalence risk increased [S2: community-dwelling: aOR2013 = 1.13 (1.10-1.16), aOR2016 = 1.22 (1.20-1.25); institutionalized: aOR2013 = 1.26 (1.21-1.32), aOR2016 = 1.44 (1.38-1.50)]. The same patterns were observed for benzodiazepine initiation. Adherence to benzodiazepine prescription recommendations (based on French prescription duration) worsened over years [prescription duration <3 months: aOR2013 = 0.90 (0.86-0.95), aOR2016 = 0.90 (0.85-0.95), single reimbursement: aOR2013 = 0.95 (0.91-1.00), aOR2016 = 0.94 (0.90-0.99)].Conclusions and ImplicationsLong half-life benzodiazepine exposure was reduced whereas short half-life benzodiazepine exposure increased, and adherence to recommendations worsened (prescription duration longer than 3 months and more than a single reimbursement in recent cohorts). Efforts from prescribers and authorities are required in order to restrict psychotropic exposure among the ADRD population. Further research among institutionalized ADRD subjects could provide useful data to disentangle the effects of changes in prescribing practices and in patients' characteristics. |
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| Keywords: | Dementia benzodiazepine trend population |
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