Incidence and predictors of new persistent benzodiazepine and Z-drug use after critical illness A nationwide cohort study.

BACKGROUND

Benzodiazepines and Z-drugs (BZRA) are commonly prescribed sedative-hypnotics but carry risks of dependence and cognitive impairment when used long-term. Patterns of new persistent BZRA use among ICU survivors remain poorly characterised.

OBJECTIVE

To determine the 6-month incidence of new persistent BZRA use following ICU admission and to identify demographic, clinical and socioeconomic risk factors.

DESIGN

A retrospective, population-based cohort study.

SETTING

National Health Insurance Service claims data, Republic of Korea; 1 January 2020 to 31 December 31, 2022.

PATIENTS: Adults (≥ 18 years) admitted to any ICU during the study period who were BZRA-naive in the 12 months before admission and survived at least 180 days (final n = 620 810).

INTERVENTIONS: None.

MAIN OUTCOME MEASURES: New persistent BZRA use was defined as at least 4 consecutive weeks of BZRA prescriptions within 6 months after the index ICU admission, permitting refill gaps of 7 days or less. We estimated cumulative incidence and used multivariable logistic regression to evaluate predictors.

RESULTS

By 6 months, 94 293 patients (15.2%) met criteria for new persistent BZRA use. In the updated multivariable model, the odds ratios (ORs) for pre-ICU admission selective serotonin reuptake inhibitor (SSRI) use was 1.78 [95% confidence interval (CI), 1.74 to 1.82] and for opioid use 1.41 (95% CI, 1.38 to 1.43) (both P < 0.001). Even after adjusting for these, pre-existing psychiatric disorders remained the strongest predictors: ORs insomnia = 2.06 (95% CI, 2.00 to 2.11), anxiety = 1.55 (95% CI, 1.51 to 1.59), depression = 1.32 (95% CI, 1.28 to 1.36) and bipolar disorder = 1.27 (95% CI, 1.23 to 1.30), all P values < 0.001. Female sex, socioeconomic disadvantage (as indicated by Medical Aid status) and extracorporeal membrane oxygenation support also independently increased the risk: ORs were 1.23 (95% CI, 1.21 to 1.24), 1.06 (95% CI, 1.03 to 1.10) and 1.07 (95% CI, 1.03 to 1.12), respectively.

CONCLUSIONS

Nearly one in six ICU survivors developed new persistent BZRA use. Along with psychiatric comorbidities and female sex, pre-ICU exposure to SSRIs and opioids identified patients at particularly high risk.