Long-term sedative use among community-dwelling adults: a population-based analysis

Abstract

Background: Chronic use of benzodiazepines and benzodiazepine-like sedatives (z-drugs) presents substantial risks to people of all ages. We sought to assess trends in long-term sedative use among community-dwelling adults in British Columbia.

Methods: Using population-based linked administrative databases, we examined longitudinal trends in age-standardized rates of sedative use among different age groups of community-dwelling adults (age ≥ 18 yr), from 2004 to 2013. For each calendar year, we classified adults as nonusers, short-term users, or long-term users of sedatives based on their patterns of sedative dispensation. For calendar year 2013, we applied cross-sectional analysis and estimated logistic regression models to identify health and socioeconomic risk factors associated with long-term sedative use.

Results: More than half (53.4%) of long-term users of sedatives in British Columbia are between ages 18 and 64 years (young and middle-aged adults). From 2004 to 2013, long-term sedative use remained stable among adults more than 65 years of age (older adults) and increased slightly among young and middle-aged adults. Although the use of benzodiazepines decreased during the study period, the trend was offset by equal or greater increases in long-term use of z-drugs. Being an older adult, sick, poor and single were associated with increased odds of long-term sedative use.

Interpretation: Despite efforts to stem such patterns of medication use, long-term use of sedatives increased in British Columbia between 2004 and 2013. This increase was driven largely by increased use among middle-aged adults. Future deprescribing efforts that target adults of all ages may help curb this trend.

Figure 1

Age-standardized prevalence of overall (short- and long-term) sedative use among community-dwelling adults aged 18 years and older in British Columbia, 2004-2013. Sedative use was defined as the filling of 1 or more sedative prescription during the calendar year. Age-standardization was performed using the 2013 population in 4 age categories (18-44, 45-64, 65-84 and ≥ 85 yr).

Figure 2

Age-standardized prevalence of overall sedative use among community-dwelling adults aged 65 years and older (A) and among community-dwelling adults aged 18-64 years (B) in British Columbia, 2004-2013. Sedative use was defined as the filling of 1 or more sedative prescription during the calendar year. Age-standardization was performed using the 2013 population in 4 age categories (18-44, 45-64, 65-84 and ≥ 85 yr).

Figure 3

Age-standardized prevalence of long-term sedative use among community-dwelling adults aged 65 years and older (A) and among community-dwelling adults aged 18-64 years (B) in British Columbia, 2004-2013. Sedative use was defined as the filling of 1 or more sedative prescription during the calendar year. Age-standardization was performed using the 2013 population in 4 age categories (18-44, 45-64, 65-84 and ≥ 85 yr).