Morgan Steven G, Weymann Deirdre
School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada.
British Columbia Cancer Agency, Canadian Centre for Applied Research in Cancer Control, 675 W 10th Ave, Vancouver, BC, V5Z 1L3, Canada.
Eur J Clin Pharmacol. 2017 Aug;73(8):1001-1008. doi: 10.1007/s00228-017-2253-z. Epub 2017 Apr 24.
Benzodiazepines and benzodiazepine-like sedatives (zopiclone, zolpidem and zaleplon) are commonly prescribed to treat anxiety and insomnia but are contraindicated for chronic use. We sought to study the persistence, over multiple years, of chronic use of benzodiazepines and benzodiazepine-like sedatives among community-dwelling adults in British Columbia, Canada.
This is a retrospective analysis of linked health data for adults aged 50 to 69 in 2004 who resided in British Columbia, Canada, between 2004 and 2013. We assigned subjects to one of four groups according to the total number of days of benzodiazepines and benzodiazepine-like sedatives that they were dispensed from retail pharmacies in each observation year. We estimated logistic regression models to measure associations between the odds of chronic sedative use and explanatory variables. We computed transition probability matrices that depict likelihood of changes in sedative utilization levels across years.
Nearly one in ten (9.4%) community-dwelling older adults in British Columbia filled prescriptions with more than 90 days' worth of benzodiazepines or benzodiazepine-like sedatives in 2013. The odds of such chronic sedative use were higher for people who were older, had lower income, were sicker, or lived in rural communities; odds were lower for people with Chinese or South Asian surnames and for men who were married. Controlling for other factors, chronic users of sedatives in 2008 were 15 times more likely than non-users of sedatives in 2008 to be chronic sedative users in 2013 (OR = 14.73; 95% CI = [14.24, 15.24]). Approximately two out of every five older British Columbians who were chronic sedative users in 2013 had been chronic users of sedatives 10 years prior. Two out of every three chronic sedative users in 2004 were either chronic users (57%) or dead (16%) by 2013.
Chronic use of sedatives is prevalent and persistent among older adults in British Columbia. The persistence of chronic sedative use between when patients were 50 to 59 years old and when they were 60 to 69 years old suggests that earlier interventions to curb chronic sedative use may be warranted even if patients do not experience significant risks until later ages.
苯二氮䓬类药物和苯二氮䓬类镇静剂（佐匹克隆、唑吡坦和扎来普隆）常用于治疗焦虑和失眠，但禁止长期使用。我们试图研究加拿大不列颠哥伦比亚省社区居住成年人中苯二氮䓬类药物和苯二氮䓬类镇静剂长期使用情况在多年间的持续性。
这是一项对2004年年龄在50至69岁、2004年至2013年居住在加拿大不列颠哥伦比亚省成年人的关联健康数据进行的回顾性分析。我们根据各观察年份从零售药店配得的苯二氮䓬类药物和苯二氮䓬类镇静剂的总天数，将受试者分为四组。我们估计逻辑回归模型以衡量长期使用镇静剂的几率与解释变量之间的关联。我们计算了描述各年份镇静剂使用水平变化可能性的转移概率矩阵。
2013年，不列颠哥伦比亚省近十分之一（9.4%）的社区居住老年人开具了超过90天用量的苯二氮䓬类药物或苯二氮䓬类镇静剂处方。年龄较大、收入较低、病情较重或居住在农村社区的人长期使用此类镇静剂的几率较高；姓氏为中文或南亚姓氏的人和已婚男性的几率较低。在控制其他因素后，2008年的镇静剂长期使用者在2013年成为镇静剂长期使用者的可能性是非2008年镇静剂使用者的15倍（比值比=14.73；95%置信区间=[14.24, 15.24]）。2013年每五名不列颠哥伦比亚省老年镇静剂长期使用者中约有两人在10年前就是镇静剂长期使用者。2004年每三名镇静剂长期使用者中，到2013年有两人要么仍是长期使用者（57%），要么已去世（16%）。
在不列颠哥伦比亚省的老年人中，镇静剂的长期使用普遍且持续存在。患者在50至59岁和60至69岁时镇静剂长期使用情况的持续性表明，即使患者直到较晚年龄才面临重大风险，也可能有必要尽早采取干预措施来遏制镇静剂的长期使用。
