(ASPOT47) Utilization of Benzodiazepines in the U.S.: An Analysis of Medical Expenditure Panel Survey

Background: The American Geriatrics Society’s Beers Criteria recommend avoiding benzodiazepines in older adults due to increased risk of falls, fracture and death. Individuals with cognitive impairment are particularly vulnerable to higher risk of adverse events associated with benzodiazepines.

Objectives: To describe predictors of and trends in benzodiazepine use among older adults in the United States (U.S.).

Methods: We conducted a retrospective cohort study of older adults (age>=65) using Medical Expenditure Panel Survey data from 2016 through 2021. Benzodiazepine use was defined as individuals who had at least one prescription of long or short acting benzodiazepines. Patient characteristics included age, sex, race/ethnicity, education, income, marital status, region, year and cognitive impairment. All individuals were classified as having cognitive impairment or not based on a question that asked if individuals had difficulty concentrating, remembering and making decisions and ICD-10-CM codes (G30 and F03). We used descriptive statistics to characterize the study cohort. We constructed a logistic regression model to determine the association of patient characteristics with benzodiazepine use. To test for trends over time, we used weighted linear regression models with the proportion of older adults who used benzodiazepines as the outcome and year as the independent variable.

Results: The number of older adults ranged from 49.9 million (95% confidence interval [CI], 46.7-53.1) to 56.8 million (95% CI, 52.3 – 61.4) from 2016 through 2021. The mean age of the entire cohort was 73.8±6.4 years, 54.7% were female, 75.4% were non-Hispanic White, and 2.4% had cognitive impairment. Overall, benzodiazepine use was greater among people with cognitive impairment than without (11.6% vs. 7.0%; unadjusted odds ratio [OR] 1.73, 95% CI 1.21-2.45). After controlling for patient characteristics, cognitive impairment was significantly associated with an increased risk of benzodiazepine use (OR, 1.59, 95% CI, 1.10-2.30). Benzodiazepine use among older adults, in general, declined from 9.0% (95% CI, 6.0-10.0) in 2016 to 5.6% (95% CI, 4.9-6.3) in 2021 (p < 0.0001), and also declined among individuals without cognitive impairment (8.7% in 2016 to 5.5% in 2021, p< 0.0001). Although the use declined among individuals with cognitive impairment, it was not statistically significant (17.8% in 2016 to 8.4% in 2021, p=0.839).

Conclusions: While overall benzodiazepine use among older adults in the U.S. decreased over six years, those with cognitive impairment faced an elevated risk of receiving potentially inappropriate benzodiazepines.