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.
MethodsAnalyzed 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.
ResultsOf 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%).
ConclusionsFindings 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.
