Table 4.
Independent Predictors of Long-term Benzodiazepine Treatment (6+ Months) in Children and Adolescentsa,b
| Children (3–12 years) | Adolescents (13–17 years) | |||||
|---|---|---|---|---|---|---|
| Variable | Total, N=20,386 | Long-term use, (N=1,284) | Total, N=51,390 | Long-term use, (N=3,477) | ||
| n | ARR (95% CI) | n | ARR (95% CI) | |||
| Female | 9,441 | 580 | 1.05 (0.95, 1.17) | 30,852 | 1,922 | 0.82 (0.76, 0.87) |
| Age at BZD start | ||||||
| 10–12 years (vs 3–9) | 10,069 | 606 | 1.01 (0.91, 1.13) | – | ||
| 16–17 years (vs 15–14) | – | 29,058 | 2,092 | 1.14 (1.07, 1.22) | ||
| Potential indication, prior 30 days | ||||||
| Epilepsy, convulsions | 2,561 | 466 | 3.01 (2.61, 3.46) | 1,952 | 217 | 1.70 (1.46, 1.98) |
| Bipolar disorder, schizophrenia, psychosis | 387 | 44 | 1.02 (0.75, 1.39) | 2,520 | 383 | 1.26 (1.12, 1.42) |
| Conduct/disruptive disorder | 571 | 64 | 0.94 (0.74, 1.21) | 1,026 | 125 | 0.95 (0.80, 1.13) |
| Sleep problems | 544 | 86 | 1.72 (1.38,2.16) | 1,677 | 191 | 1.40 (1.21, 1.61) |
| Depression | 724 | 63 | 0.98 (0.76, 1.28) | 9,849 | 1,140 | 1.13 (1.04, 1.23) |
| Anxiety disorder | 3,487 | 252 | 0.92 (0.78, 1.08) | 16,125 | 1,501 | 1.13 (1.06, 1.21) |
| Muscle spasm, movement disorder | 1,958 | 184 | 1.47 (1.25, 1.73) | 2,247 | 167 | 1.32 (1.12, 1.54) |
| Musculoskeletal condition | 5,090 | 122 | 0.65 (0.53, 0.79) | 11,301 | 362 | 0.82 (0.73, 0.92) |
| Injury | 2,609 | 60 | 0.86 (0.66, 1.12) | 6,335 | 216 | 0.82 (0.72, 0.94) |
| Prescribing cautions, prior year | ||||||
| Drug-related disorder | – c | 1,910 | 247 | 1.16 (1.01, 1.33) | ||
| Alcohol related disorder | – c | 544 | 69 | 1.07 (0.84, 1.36) | ||
| Self-harm, suicidal ideation diagnosis | 146 | 19 | 1.35 (0.86, 2.13) | 2,484 | 329 | 1.00 (0.89, 1.14) |
| Poisoning | 198 | 12 | 0.66 (0.38, 1.15) | 1,389 | 163 | 1.02 (0.86, 1.20) |
| Sleep apnea, hypersomnia | 582 | 90 | 1.58 (1.27, 1.95) | 719 | 104 | 1.61 (1.34, 1.92) |
| Respiratory failure, hypoxemia | 463 | 60 | 1.31 (1.00, 1.72) | 364 | 38 | 1.83 (1.34, 2.49) |
| Opioid prescription, prior 30 day (ref=none) | 15,918 | 1,244 | ref | 40,531 | 3,274 | ref |
| Same day as benzodiazepine start | 3,604 | 18 | 0.12 (0.08, 0.20) | 8,387 | 52 | 0.16 (0.12, 0.21) |
| Prior 30 days (excluding day of BZD initiation) | 864 | 22 | 0.50 (0.33, 0.76) | 2,472 | 151 | 1.08 (0.92, 1.27) |
| Psychiatric inpatient admission, prior 30 days | 544 | 71 | 1.16 (0.91, 1.47) | 2,403 | 324 | 1.03 (0.90, 1.17) |
| Complex chronic condition | 2,929 | 253 | 1.73 (1.48, 2.03) | 3,765 | 188 | 1.18 (1.01, 1.38) |
| Health professional contact, prior 30 days | ||||||
| Mental health specialist | 3,760 | 368 | 1.46 (1.26, 1.69) | 14,886 | 1,782 | 1.53 (1.42, 1.66) |
| General medical specialist | 10,131 | 604 | 0.89 (0.80, 0.99) | 26,217 | 1,675 | 0.91 (0.85, 0.97) |
| Neurology | 2,406 | 312 | 1.19 (1.03, 1.38) | 3,120 | 246 | 1.30 (1.12, 1.50) |
| Surgery, radiology, anesthesiology | 5,773 | 200 | 0.68 (0.58, 0.80) | 11,497 | 367 | 0.68 (0.60, 0.76) |
Model includes children and adolescents with at least 6 months of continuous insurance enrollment after benzodiazepine initiation.
Variables not displayed but included in multivariable model (ARR, 95% CI): psychotropic prescriptions, prior 30 days for children [SSRI=1.23 (1.05, 1.45); other antidepressant=1.46 (1.18, 1.81); atomoxetine, hydroxyzine, clonidine, or guanfacine=1.46 (1.25, 1.69); stimulant=1.13 (0.96, 1.32); antipsychotic=1.45 (1.22, 1.72)] and adolescents [ARRs: SSRI=1.34 (1.25, 1.44); other antidepressant=1.52 (1.40, 1.66); hypnotic=1.60 (1.32, 1.95); atomoxetine, hydroxyzine, clonidine, or guanfacine=1.38 (1.24, 1.53); stimulant=1.25 (1.14, 1.37); antipsychotic=1.45 (1.32, 1.59)]; other specialized pediatrics provider contact: children=1.07 (0.91, 1.27), adolescents=0.94 (0.81, 1.09); Inpatient non-psychiatric hospitalizations not included in model given concordance with complex chronic condition.
Not included in multivariable model given low number.
BZD, benzodiazepine; ARR, adjusted risk ratio.