Department of Epidemiology and Public Health (JSA, AV), University of Maryland School of Medicine, Baltimore.
the Department of Psychiatry (EMW), University of Maryland School of Medicine, Baltimore; the Sleep Disorders Center (EMW, SMS), Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore.
Am J Geriatr Psychiatry. 2019 Mar;27(3):301-309. doi: 10.1016/j.jagp.2018.10.017. Epub 2018 Nov 2.
Insomnia is an important clinical problem affecting the elderly. We examined trends in insomnia diagnosis and treatment among Medicare beneficiaries over an eight-year period.
This was a time-series analysis of Medicare administrative data for years 2006-2013. Insomnia was defined as the presence of at least one claim containing International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 307.41, 307.42, 307.49, 327.00, 327.01, 327.09, 780.52, or V69.4 in any given year. Insomnia medications were identified by searching the Part D prescription drug files in each year for barbiturates, benzodiazepines, chloral hydrate, hydroxyzine, nonbenzodiazepine sedative hypnotics, and sedating antidepressants.
Prevalence of physician-assigned insomnia diagnoses increased from 3.9% in 2006 to 6.2% in 2013. Prevalence of any insomnia medication use ranged from 21.0% in 2006 to 29.6% in 2013 but remained steady. A sharp increase in use of benzodiazepines from 2012-2013 (1.1% to 17.6%) drove up total insomnia medication use for 2013. Prevalence of both insomnia diagnosis and medication use ranged from 3.5% in 2006 to 5.5% in 2013, while prevalence of either insomnia diagnosis or medication use ranged from 22.7% in 2006 to 31.0% in 2013.
In this large national analysis of Medicare beneficiaries, prevalence of physician-assigned insomnia diagnoses was low but increased over time. Prevalence of insomnia medication use was up to four-times higher than insomnia diagnoses and remained steady over time. Notably, prevalence of benzodiazepine use increased dramatically from 2012-2013 after these medications were included in the Medicare Part D formulary.
失眠是影响老年人的一个重要临床问题。我们研究了在八年期间 Medicare 受益人的失眠诊断和治疗趋势。
这是对 2006 年至 2013 年 Medicare 管理数据进行的时间序列分析。失眠的定义为至少有一次在任何一年中含有国际疾病分类，第九版临床修订版（ICD-9-CM）代码 307.41、307.42、307.49、327.00、327.01、327.09、780.52 或 V69.4 的索赔。在每年的 Part D 处方药档案中搜索巴比妥类药物、苯二氮䓬类药物、水合氯醛、羟嗪、非苯二氮䓬类镇静催眠药和镇静抗抑郁药来确定失眠药物。
医生诊断失眠的患病率从 2006 年的 3.9%增加到 2013 年的 6.2%。任何失眠药物的使用的患病率从 2006 年的 21.0%到 2013 年的 29.6%，但保持稳定。2012 年至 2013 年苯二氮䓬类药物的使用急剧增加（从 1.1%增加到 17.6%），导致 2013 年失眠药物的总使用量增加。2006 年至 2013 年，失眠诊断和药物使用的患病率均为 3.5%至 5.5%，而失眠诊断或药物使用的患病率为 22.7%至 31.0%。
在这项针对 Medicare 受益人的大型全国性分析中，医生诊断失眠的患病率较低，但随时间推移而增加。失眠药物的使用患病率是失眠诊断的四倍多，且随时间保持稳定。值得注意的是，在这些药物被纳入 Medicare Part D 处方集后，2012 年至 2013 年苯二氮䓬类药物的使用量急剧增加。
