Resumen de Use of benzodiazepines in primary care: prescriptions from 2010 to 2019 in Catalonia

Antonieta Also Fontanet, Sandra Murgui, Elisenda Sant, Mireia Sans Corrales, Antoni Sisó Almirall, Ariadna Mas, Clàudia Valenzuela Pascual, Gerard Anmella Diaz, Jordi Blanch, Myriam Cavero, Eduard Vieta i Pascual, Diego Alberto Hidalgo Mazzei

• Background and objectives Benzodiazepine (BZD) consumption has increased globally, with Spain among the highest-use countries. This study examines factors associated with intensive BZD in Catalonia’s primary care (PC) from 2010–2019.

  Methods Analyzed data from 713,196 adults attending PC without mental health service contact, excluding children, adolescents, and individuals with alcohol use disorders. Intensive BZD use was defined as >56 Defined Daily Doses within an 8-week period. A hurdle model with a negative binomial distribution assessed factors influencing initiation and duration of intensive prescriptions. Multiple imputation addressed missing covariates.

  Results Of the study population, 67,184 adults (9.4%) received intensive BZD prescriptions in at least one year. Persistent users—those with prescriptions in all 10 follow-up years—numbered 6,767 and were predominantly female (81.6%) and Spanish nationals (99.2%). After adjustment, 54 of 92 associations (58.7%) remained significant. The strongest for sex, hypertension, and nationality:Females showed a 39% increase in the odds of heavy BZD use, while non-Spanish nationality was associated with a 45% reduction. Hypertension increased the odds by 57%, constituting comorbidity with the greatest impact on heavy use.Among persistent users, the most frequent diagnoses were anxiety (15.1%), insomnia (13.3%), and depression (8.5%).

  Conclusions Findings show initiation and persistence of intensive BZD use are influenced by different factors: initiation relates to sociodemographic characteristics, while persistence is driven by medical complexity. Women, Spanish nationals, and patients with hypertension are at highest risk of long-term use, underscoring the need for targeted interventions and deprescribing strategies.