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The Association Between Dementia and Long-Term Use of Benzodiazepine in the Elderly: Nested Case–Control Study Using Claims Data

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Objectives:

The aim of this study was to examine the association between long-term benzodiazepines (BZDs) use and the risk of dementia.

Design:

Population-based nested case–control study of dementia.

Setting:

All subjects were aged 45 and older and enrolled in the National Health Insurance Research Database in Taiwan, 1997–2004.

Participants:

Cases (N = 779) were patients who were identified with dementia at least two times in their outpatient claims. They were individually matched to six comparison subjects (N = 4,626) based on age and gender.

Measurements:

BZD usage (average dosage per year, average days per year, and cumulative dose and periods) and potential confounding comobidities, including cardiovascular and psychiatric diseases.

Results:

Subjects with dementia had higher cumulative dose, longer duration of BZDs exposure, and more likelihood to be long-term BZDs users.

Conclusion:

Our findings suggest that long-term use of BZDs is associated with an increased risk for dementia, but the underlying mechanisms remain unclear, and further investigations are needed. Long-term use of BZDs should be avoided among the elderly, who may be at a higher risk for developing dementia, in addition to other health problems.

Section snippets

Study Setting

Data for this study were obtained from the ambulatory claims database of the National Health Insurance Research Database (NHIRD). Taiwan launched a single-payer National Health Insurance (NHI) program on March 1, 1995. As of December 2003, 22.0 million individuals, representing 97% of Taiwanese population, were enrolled in this program.16 NHIs database system contains registration files, original claim data, and reimbursement data. Large computerized databases derived from this system,

RESULTS

A total of 779 cases of dementia and 4,626 of comparison subjects were included in our analysis. The mean age of this cohort was 75.6 years (SD = 9.1), with a range from 49.0 to 101.8. Cases and comparison subjects did not differ significantly in term of age (mean = 75.8 years [SD = 9.2] and 75.6 years [SD = 9.0], respectively) or sex (male ratio 46.2% and 46.4%).

Overall, 79.4% (N = 4,294) of subjects had been prescribed BZDs. Among subjects with BZDs prescribed, the mean BZDs DDD was 202.9 DDD

DISCUSSION

To the best of our knowledge, this is the first study using claims data to explore the risk of dementia and BZDs use, with population-based sampling, detailed description of BZDs prescription patterns and a well-defined method for identifying cases of dementia. We used a nested case–control design to assess BZDs exposure preceding outcome. The results, showing significant correlations between BZDs exposure and the risk of dementia, fit our hypotheses: higher cumulative dosage and longer

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    The authors declare no conflict of interest.

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