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Articles   |    
Trends in Anxiolytic-Hypnotic Use and Polypharmacy in Taiwan, 2002–2009: A Nationwide, Population-Based Survey
Liang-Jen Wang, M.D., M.P.H.; Yi-Chih Chen, M.D.; Chih-Ken Chen, M.D., Ph.D.; Wen-Jiun Chou, M.D., M.S.; Miao-Chun Chou, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300066
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Dr. Wang, Dr. Wen-Jiun Chou, and Dr. Miao-Chun Chou are with the Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (e-mail: wangliangjen@gmail.com). Dr. Yi-Chih Chen and Dr. Chih-Ken Chen are with the Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objectives  Use of anxiolytics-hypnotics, including benzodiazepines and “z” hypnotics, is a public health concern. This study aimed to investigate the trends in prevalence of anxiolytic-hypnotic drug use and polypharmacy (simultaneous use of two or more anxiolytics-hypnotics) in Taiwan.

Methods  A dynamic sample of one million individuals who were randomly selected from the National Health Insurance database was used to detect populationwide trends in the use of anxiolytics-hypnotics in Taiwan between 2002 and 2009. The analyses included drugs that are administered orally, intravenously, or intramuscularly as well as single or compound drugs. The authors identified the number of individuals who used the drugs, the sum of days of reported drug use for all individuals (person-days), and the distribution of anxiolytic-hypnotic polypharmacy for all claims for ambulatory, pharmacy, and hospital care.

Results  Annual prevalence of any anxiolytic-hypnotic use in Taiwan was higher than 20%. The number of person-days greatly increased from 2002 (4.0%) to 2009 (6.6%). The increases in use between 2002 and 2009 were greatest for clonazepam (prevalence, 7% versus 1.8%; person-days, .2% versus .6%) and zolpidem (prevalence, 2.4% versus 4.2%; person-days, .5% versus 1.5%). Polypharmacy accounted for almost 70% of all person-days of anxiolytic-hypnotic use.

Conclusions  This nationwide, population-based survey presents real-world epidemiological evidence about anxiolytic-hypnotic use. The adverse effects of the long-term use of anxiolytics-hypnotics have been established, and unnecessary use of these drugs, particularly in polypharmacy regimens, should be avoided.

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Figure 1 Proportion of person-days of use of one, two, or three or more anxiolytics-hypnotics in Taiwan, 2002–2009a

aPerson-days are the sum of days of use of all anxiolytics-hypnotics by all individuals.

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Table 1Use of anxiolytics-hypnotics in Taiwan, 2002–2009, by percentagea
Table Footer Note

a Data are from claims for one million beneficiaries from the 2000 Registry of Beneficiaries of the National Health Insurance Research Database. Ns for the eight years ranged from 951,836 (2004) to 995,718 (2002). Participants who lacked either an identification code or birth date information were excluded from the analysis for each year.

Table Footer Note

b Form of drug: S, single; C, compound; O, oral; I, intravenous or intramuscular

Table Footer Note

c Linear models using curve estimation assessed trends in the prevalence of use of each anxiolytic-hypnotic. The t values represent the effect size of coefficients in the linear models (df=1 for the regression coefficient; df=31 for each model).

Table Footer Note

* p<.05, **p<.001

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Table 2Proportion of person-days of use of anxiolytics-hypnotics in Taiwan, 2002–2009a
Table Footer Note

a Data are reported as the proportion per 1,000 person-days. Person-days, in millions, are the sum of days of use of all anxiolytics-hypnotics by all individuals. Claims are for one million beneficiaries from the 2000 Registry of Beneficiaries of the National Health Insurance Research Database. Participants who lacked either an identification code or birth date information were excluded from the analysis for each year.

Table Footer Note

b Form of drug: S, single; C, compound; O, oral; and I, intravenous or intramuscular

Table Footer Note

c Linear models using curve estimation assessed trends in the prevalence of person-days of use of each anxiolytic-hypnotic. The t values represent the effect size of coefficients in the linear models (df=1 for the regression coefficient; df=31 for each model).

Table Footer Note

* p<.01, **p<.001

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