Abstract
Objectives: The Norwegian Government urges that actions are needed to stimulate the working capacity in disability pensioners (DPs) with such a potential. Information on factors that may impair rehabilitation efforts, including use of potentially addictive drugs, may be useful in this context. Thus, the aim was to study the association between DP on initiation as well as long-term use of benzodiazepines (BZDs), and to describe aspects of problematic use of BZDs in terms of: long-term use pattern, including escalation of dose over time, and use of other potentially addictive drugs.Methods: We followed a cohort of 8,942 men and 10,578 women aged 40, 45, 60 years (non-users of BZDs at baseline), who participated in health surveys in 2000-01 in three Norwegian counties, with respect to use of BZDs, and other potentially addictive drugs, by linkage to the Norwegian Prescription Database (NorPD) for 2004-2007. Information on DP status was retrieved from Statistics Norway.Results: Incident BZD use was highest among female DPs; 18-20% compared to 5-8% of the non-DPs. Multivariable analyses revealed an independent effect of DP on incident (OR 1.6 (95% CI 1.4-2.0)) and long-term use (OR 2.47 (95% CI 1.90-3.20)) of BZDs. Among incident users, 51-60% of the DPs retrieved BZDs throughout the period 2004-07, as compared to 32-33% of the non-DPs. The annual median defined daily doses (DDDs) of BZDs among long-term users increased throughout the period 2004-07, most pronounced in the youngest DPs; from 50 (interquartile range (IQR) 14,140) DDD to 205 (IQR 25,352) DDD.Conclusions: The chance of being prescribed BZDs as well as becoming a long-term user was higher among DPs. High continuation rates, with a steadily increasing annual amount of use among the long term users may reflect an unfavourable use pattern of potentially addictive drugs among DPs, most worrisome among the youngest.
Highlights
Socioeconomic inequalities of health have become an important part of the political agenda in Norway and other countries1
In a study-population reporting to be non-users of BZDs at baseline; the proportion of disability pensioners that had started benzodiazepines 3-4 years later were about fourfold among 40+45 year old and about doubled in the 60 year old compared to those registered as non-receivers of a disability pension at baseline
Mental health problems were the strongest predictor of incident and long-term BZD use, and almost half of all 40+45 year old disability pensioners in our study were registered as receivers of a disability pension
Summary
Socioeconomic inequalities of health have become an important part of the political agenda in Norway and other countries. Equal access to and quality of health care is supposed to be a fundamental part of the Norwegian welfaresystem1 In this context; drugs should be prescribed according to medical need, irrespective of socioeconomic circumstances, and problematic use of potentially addictive drugs should be avoided. An inequality in statin use, due to sosioeconomic factors and not need, would imply inquality in the prevention of one of the leading causes of death in Norway. A recent Norwegian study showed that this gradient could be explained by different cardiovascular disease (CVD) risk factor profiles (medical need) prior to the initiation of therapy, at least for primary CVD prevention. It may reflect that highly educated women may be more aware of their own health and new treatments than women of low educational level, which in turn may add up as a factor contributing to the observed social gradient in cardiovascular mortality
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