Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA.
UNC Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Am Geriatr Soc. 2023 Jun;71(6):1944-1951. doi: 10.1111/jgs.18288. Epub 2023 Feb 13.
We characterized real-world prescribing patterns of opioids and benzodiazepines (BZDs) for older adults to explore potential disparities by race and sex and to characterize patterns of co-prescribing.
A retrospective evaluation was conducted using electronic health data for adults ≥65 years old who presented to one of 15 primary care practices between 2019 and 2020 (n = 25,141). Chronic opioid and BZD users had ≥4 prescriptions in the year prior, with at least one in the last 90 or 180 days, respectively. We compared demographic characteristics between all older adults versus chronic opioid and BZD users. We used logistic regression to identify characteristics (age, sex, race, Medicaid use, fall history) associated with opioid and BZD co-prescribing.
We identified 833 (3.3%) chronic opioid and 959 chronic BZD users (3.8%) among all older adults seen in these practices. Chronic opioid users were less likely to be Black (12.7% vs. 14.3%) or other non-White race (1.4% vs. 4.3%), but more likely to be women (66.8% vs. 61.3%). A similar trend was observed for BZD users, with less prescribing among Black (5.4% vs. 14.3%) and other races (2.2% vs. 4.3%) older adults and greater prescribing among women (73.6% vs. 61.3%). Co-prescribing was observed among 15% of opioid users and 13% of BZD users. Co-prescribing was largely driven by the presence of relevant co-morbid conditions including chronic pain, anxiety, and insomnia rather than demographic characteristics.
We observed notable disparities in opioid and BZD prescribing by sex and race among older adults in primary care. Future research should explore if such patterns reflect appropriate prescribing or are due to disparities in prescribing driven by biases related to perceived risks for misuse.
本研究旨在通过对老年患者开具阿片类药物和苯二氮䓬类药物（BZDs）的真实世界处方模式进行描述，以探索不同种族和性别的潜在差异，并分析这两种药物的联合使用模式。
本研究为回顾性研究，使用了 2019 年至 2020 年期间 15 家初级保健诊所中≥65 岁成年人的电子健康数据（n=25141）。慢性阿片类药物和 BZD 使用者在过去 1 年中有≥4 次处方，其中至少有 1 次在过去 90 或 180 天内。我们比较了所有老年患者与慢性阿片类药物和 BZD 使用者的人口统计学特征。使用逻辑回归识别与阿片类药物和 BZD 联合使用相关的特征（年龄、性别、种族、医疗补助使用情况、跌倒史）。
在这些诊所就诊的所有老年患者中，我们确定了 833 例（3.3%）慢性阿片类药物使用者和 959 例（3.8%）慢性 BZD 使用者。与慢性阿片类药物使用者相比，慢性阿片类药物使用者中黑人（12.7% vs. 14.3%）或其他非白人种族（1.4% vs. 4.3%）的比例较低，但女性比例（66.8% vs. 61.3%）较高。BZD 使用者也存在类似的趋势，黑人（5.4% vs. 14.3%）和其他种族（2.2% vs. 4.3%）的 BZD 使用率较低，而女性（73.6% vs. 61.3%）的使用率较高。在 15%的阿片类药物使用者和 13%的 BZD 使用者中观察到了联合用药。联合用药主要是由相关合并症引起的，包括慢性疼痛、焦虑和失眠，而不是由与潜在误用风险相关的偏见导致的人口统计学特征。
我们观察到初级保健中老年患者在阿片类药物和 BZD 处方方面存在显著的性别和种族差异。未来的研究应探讨这些模式是否反映了适当的处方，还是由于与潜在误用风险相关的偏见导致的处方差异。
