Abstract
Objective
To estimate the rate of new chronic benzodiazepine use after hospitalization in older adults not previously prescribed with benzodiazepines.
Design
Retrospective cohort study using linked, population-based administrative data.
Setting
Ontario, Canada between April 1, 1992 and March 31, 2005.
Participants
Community-dwelling seniors who had not been prescribed benzodiazepine drugs in the year before hospitalization were selected from all 1.4 million Ontario residents aged 66 years and older.
Main Outcome Measures
New chronic benzodiazepine users, defined as initiation of benzodiazepines within 7 days after hospital discharge and an additional claim within 8 days to 6 months. We used multivariate logistic regression to examine for the effect of hospitalization on the primary outcome after adjusting for confounders.
Results
There were 405,128 patient hospitalizations included in the cohort. Benzodiazepines were prescribed to 12,484 (3.1%) patients within 7 days of being discharged from hospital. A total of 6,136 (1.5%) patients were identified as new chronic benzodiazepine users. The rate of new chronic benzodiazepine users decreased over the study period from 1.8% in the first year to 1.2% in the final year (P < .001). Multivariate logistic regression found that women, patients admitted to the intensive care unit or nonsurgical wards, those with longer hospital stays, higher overall comorbidity, a prior diagnosis of alcoholism, and those prescribed more medications had significantly elevated adjusted odds ratios for new chronic benzodiazepine users. Older individuals had a lower risk for the primary outcome.
Conclusion
New benzodiazepine prescription after hospitalization occurs frequently in older adults and may result in chronic use. A systemic effort to address this risky practice should be considered.
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Acknowledgements
This study was supported by a Canadian Institutes of Health Research (CIHR) Chronic Disease New Emerging Team (NET) program grant (NET 54010). The NET program receives joint sponsorship from the Canadian Diabetes Association, the Kidney Foundation of Canada, the Heart and Stroke Foundation of Canada, and the CIHR Institutes of Nutrition, Metabolism and Diabetes and Circulatory and Respiratory Health. Dr. Bell, Dr. Bronskill, and Dr. Wodchis were supported by New Investigator Awards from the CIHR. Dr. Gill was supported by an Ontario Ministry of Health and Long-term Care Career Scientist Award. Dr. Anderson was supported by a Chair in Health Management Strategies from the University of Toronto. Dr. Rochon was supported by a CIHR Investigator Award and through a Premiers Research Excellence Award. Sponsor Role: The funding agencies had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.
Conflicts of Interest/Financial Disclosures
Dr. Lee’s fellowship was sponsored in part by a grant from Eli Lilly Canada. Dr. Lee has received honoraria from Janssen, Novartis, and Pfizer. Dr. Herrmann has received research support and speaker’s honoraria from Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, and Pfizer. Dr. Fischer was employed by Bayer Canada until 2004.
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Appendices
Appendix
Exclusion Codes
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1.
Psychiatry consult during the hospital stay (as described by one of the variables mdserv#1–8 = 64 before 2002 or prvserv1–8 = 00064 from 2002)
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2.
Exclude all subjects in palliative care (OHIP fee code A945, C945, C882, or C982, W872, W882, W972, or W982 or CIHI record with patserv = 58).
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3.
Long-term care residents were identified by an LTC flag in the ODB Database.
List of benzodiazepines included on ODB plan, which were included in the analysis
ICU and Alcoholism Coding
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1.
ICU stay during index hospitalization (i.e., between admission and discharge dates, inclusive.). ICU stay was identified using OHIP ICU codes42:
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Comprehensive care–intensive care area (covers all aspects of ICU care including mechanical ventilation): G557-day 1 only, G558-day 2–10 inclusive, G559-day 11 onward.
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Critical care–intensive care area (covers all aspects of ICU excluding mechanical ventilation): G400-day 1 only, G401-days 2–10 inclusive, G402-Days 11 onward.
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Ventilatory support–intensive care area (covers management of mechanical ventilation only): G405-day 1 only, G406-days 2–10 inclusive, G407-days 11 onward.
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1.
Alcoholism based on any (not only primary diagnosis) admission diagnosis within the past 3 years (including index hospitalization) (for ICD-9-any CIHI dxcode: V113, 2911, 2913–2919, 3030, 3050, 3575, 4255, 5353, 5710–5713, 7903, 9808, 9809. For ICD-10-F100-F109, G621, I426, K292, K700–K704, K709, R780, T518, T519, Y910–Y913, Y919, Z811) or OHIP visit within past 3 years (OHIP dxcode: 291, 303).
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Bell, C.M., Fischer, H.D., Gill, S.S. et al. Initiation of Benzodiazepines in the Elderly After Hospitalization. J GEN INTERN MED 22, 1024–1029 (2007). https://doi.org/10.1007/s11606-007-0194-4
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DOI: https://doi.org/10.1007/s11606-007-0194-4