RT Journal Article SR Electronic T1 Effort–reward imbalance and long-term benzodiazepine use: longitudinal findings from the CONSTANCES cohort JF Journal of Epidemiology and Community Health JO J Epidemiol Community Health FD BMJ Publishing Group Ltd SP 993 OP 1001 DO 10.1136/jech-2019-212703 VO 73 IS 11 A1 Guillaume Airagnes A1 Cédric Lemogne A1 Sofiane Kab A1 Nicolas Hoertel A1 Marcel Goldberg A1 Morten Wahrendorf A1 Johannes Siegrist A1 Yves Roquelaure A1 Frédéric Limosin A1 Marie Zins YR 2019 UL http://jech.bmj.com/content/73/11/993.abstract AB Objectives To examine the association between effort–reward imbalance and incident long-term benzodiazepine use (LTBU).Methods We included 31 077 employed participants enrolled in the French population-based CONSTANCES cohort between 2012 and 2014 who had not undergone LTBU in the 2 years before enrolment. LTBU was examined using drug reimbursement administrative databases. The effort–reward imbalance was calculated in quartiles. We computed ORs (95% CIs) for LTBU according to effort–reward imbalance over a 2-year follow-up period. We adjusted for age, gender, education, occupational grade, income, marital status, tobacco smoking, risk of alcohol use disorder, depressive symptoms and self-rated health.Results Over the 2-year follow-up, 294 (0.9%) participants experienced incident LTBU. In the univariable analysis, effort–reward imbalance was associated with subsequent LTBU with ORs of 1.79 (95% CI 1.23 to 2.62) and 2.73 (95% CI 1.89 to 3.95) for the third and fourth quartiles, respectively, compared with the first quartile. There was no interaction between effort–reward imbalance and any of the considered variables other than tobacco smoking (p=0.033). The association remained significant in both smokers and non-smokers, with higher odds for smokers (p=0.031). In the fully adjusted model, the association remained significant for the third and fourth quartiles, with ORs of 1.74 (95% CI 1.17 to 2.57) and 2.18 (95% CI 1.50 to 3.16), respectively. These associations were dose dependent (p for trend <0.001).Conclusions Effort–reward imbalance was linked with incident LTBU over a 2-year follow-up period after adjustment for sociodemographic and health-related factors. Thus, screening and prevention of the risk of LTBU should be systematised among individuals experiencing effort–reward imbalance, with special attention paid to smokers.