美国私人保险覆盖的儿童和青少年中苯二氮䓬类药物的处方使用情况。
Prescription Benzodiazepine Use in Privately Insured U.S. Children and Adolescents.
机构信息
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey.
出版信息
Am J Prev Med. 2019 Dec;57(6):775-785. doi: 10.1016/j.amepre.2019.07.006.
INTRODUCTION
Benzodiazepines are commonly prescribed in the U.S. but entail safety concerns, including dependency. In pediatrics, many indications lack trial data. Authors aimed to describe youth initiating prescription benzodiazepine treatment, identify potential indications and prescribing concerns, estimate the duration of treatment by potential indication, and identify factors that predict long-term use.
METHODS
The study cohort included children (aged 3-12 years) and adolescents (aged 13-17 years) initiating prescription benzodiazepine treatment (≥3 days' supply) from January 2010 to September 2015 in a U.S. commercial claims database. Potential indications included selected ICD-9-CM diagnoses (≤30 days prior). Long-term (≥6 months) benzodiazepine treatment was estimated with Kaplan-Meier estimation and modified Poisson regression identified independent predictors of long-term benzodiazepine treatment (analysis completed in 2018).
RESULTS
Of 24,504 children and 61,046 adolescents initiating benzodiazepines, 62% of the children and 68% of the adolescents had a potential indication. Anxiety disorders were the most common indication, with mental health indications more common among adolescents (45%) than children (23%) and epilepsy and movement disorders higher in children. Recent opioid prescriptions were common before benzodiazepine initiation (children, 22%; adolescents, 21%). Six percent of the initiators became long-term benzodiazepine users. Potential indication, provider contact, psychotropic medication, and chronic conditions independently predicted long-term benzodiazepine treatment in adolescents and children.
CONCLUSIONS
U.S. children and adolescents are prescribed benzodiazepines for various mental health and other medical conditions, many lacking evidence of pediatric efficacy. Long-term benzodiazepine treatment, concurrent opioid prescriptions, psychotropic use, and prior substance use disorder diagnoses suggest safety risks among some youth prescribed benzodiazepines.
简介
苯二氮䓬类药物在美国被广泛应用，但存在安全问题，包括依赖。在儿科领域，许多适应证缺乏临床试验数据。作者旨在描述开始处方苯二氮䓬类药物治疗的青少年，确定潜在的适应证和开处方的关注点，根据潜在适应证估计治疗持续时间，并确定预测长期使用的因素。
方法
研究队列包括 2010 年 1 月至 2015 年 9 月在美国商业索赔数据库中开始处方苯二氮䓬类药物（≥3 天供应量）的儿童（年龄 3-12 岁）和青少年（年龄 13-17 岁）。潜在适应证包括选择的 ICD-9-CM 诊断（≤30 天前）。使用 Kaplan-Meier 估计法估计长期（≥6 个月）苯二氮䓬类药物治疗，并用修正泊松回归识别长期苯二氮䓬类药物治疗的独立预测因素（2018 年完成分析）。
结果
在 24504 名儿童和 61046 名青少年中，62%的儿童和 68%的青少年有潜在适应证。焦虑障碍是最常见的适应证，精神健康适应证在青少年（45%）中比儿童（23%）更常见，而癫痫和运动障碍在儿童中更常见。苯二氮䓬类药物治疗开始前，最近有阿片类药物处方的情况很常见（儿童 22%；青少年 21%）。6%的开始治疗者成为长期苯二氮䓬类药物使用者。潜在适应证、提供者接触、精神药物和慢性疾病是青少年和儿童长期苯二氮䓬类药物治疗的独立预测因素。
结论
美国儿童和青少年因各种精神健康和其他医疗状况而开具苯二氮䓬类药物处方，其中许多缺乏儿科疗效的证据。长期苯二氮䓬类药物治疗、同时开具阿片类药物处方、精神药物使用和既往物质使用障碍诊断表明，一些开具苯二氮䓬类药物的青少年存在安全风险。
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