Title : Benzodiazepines and Z-drugs prescription patterns over the time 2009–2015 in the Aberdeen Children of the 1950s: Mixed methods
Abstract:
Background: Benzodiazepines and Z-drugs (BZD) are ongoing concerns due to dependence and associated risks of falls, care accidents, cognitive impairment and death. Limited evidence examined the changes in BZD prescriptions after the Committee of Safety on Medicine advise on their prescriptions in 1988. Additionally, little is known about patient-related characteristics, including childhood. This project aimed to describe the trends of ‘ever’ and ‘chronic/recurrent’ BZD prescriptions in Scotland, UK and to characterise those on BZD prescriptions, with a focus on childhood characteristics.
Methods: A mixed methodology project in which, the first part incorporated systematic reviews to examine the changes in BZD prescriptions since 1988 in a developed country, Scotland, and inform the current state of evidence. Additionally, patient-perception in BZD prescriptions was examined. Following this a population-based birth cohort (the Aberdeen Children of the 1950s) was enhanced by linkage to several Scottish administrative healthcare records to describe the changes in ever and chronic BZD prescription in Scotland and to identify life-course predictors for BZD use, using cross-sectional analysis with a focus on childhood characteristics. The trends of ‘ever’ and ‘chronic/recurrent’ BZD prescription were described. Poisson regression models were used to statistically investigate the proposed relationship between given characteristics and examined outcomes.
Results: Initiating BZD prescriptions are common in the general population of the developed countries with up to a third having BZD prescriptions chronically, especially in more deprived groups. Unlike the middle-age group, the elderly group showed declining trends in initiating BZD prescriptions. however, limited data exist on describing the changes of chronic BZD prescriptions over the time. Women, those who have disadvantage socioeconomic status and experience difficult social circumstances, have impacted health, experience significant life events like being diagnosed for the first time with a chronic condition, and/or impacted resilience, are at a higher risk of being prescribed BZD compared to those who are not. Additionally, inconsistent evidence and heterogeneities between studies have hampered the conclusion about the relationship between BZD ‘ever’ or ‘chronic/recurrent’ prescriptions and hospital admissions (psychiatric or general), ethnicity, and culture.
The data linkage study showed that prescribing BZD were common in middle-age (20.4%, [95% CI: 19.7, 21.2]), with persistent annual prevalences at about 7%. Although the incidence of ‘ever’ BZD prescriptions was declining, one in five continued to receive BZD ‘chronically/recurrently’. Additionally, the study showed that childhood behavioural disturbances and low achievements in IQ tests were independently associated with 20% and 15% increases in ‘ever’ and ‘chronic/recurrent’ BZD prescriptions risks, respectively. Moreover, additional risks of BZD prescriptions in those with behavioural disturbances and low IQ achievement were explained by multimorbidity, socioeconomic burden, and hospital admissions.
Conclusions: The rate of prescribing BZD amongst middle-age is concerning despite the decline in the incidence of their prescriptions. Behavioural disturbances and low IQ achievement in childhood are predictors for ‘ever’ and ‘chronic/recurrent’ BZD prescriptions in middle-age. Childhood is a sensitive development period in which the exposure to disadvantaged socioeconomic and social circumstances could impact individuals’ ability to cope effectively with challenges individuals may face during adulthood and/or may set a trajectory for disadvantaged socioeconomic and social circumstances across life. This may trigger the need for BZD prescriptions to enable coping. Furthermore, multimorbidity and socioeconomic burden were shown to contribute to the indirect mechanism between childhood predictors and BZD prescriptions. Future research is needed to determine how hospital admissions influence prescribing of BZD.
