Trends in benzodiazepine and alternative hypnotic use in relation with multimorbidity among older adults in Quebec, Canada

Background: Benzodiazepines and other hypnotic alternatives are associated with increased risks of adverse events. Heightened awareness of risks may have changed prescribing habits over the years. However, these trends are not fully described, especially in vulnerable people such as multimorbid older adults. Objective: We aimed to describe the annual prevalence of benzodiazepine and other hypnotic use in relation to multimorbidity among older adults in the province of Quebec, Canada, from 2000 to 2016. Method: We conducted a population-based study using the Quebec Integrated Chronic Disease Surveillance System. We included all individuals aged ≥66 years covered by the public drug plan. For each year, we evaluated the sex- and age-standardized proportion of benzodiazepine and other hypnotic users, defined as individuals with at least one drug claim in the year. We stratified our results according to multimorbidity and used log-binomial regression to study trends. Results: The proportion of individuals using benzodiazepines decreased from 34.8% in 2000 to 24.8% in 2016 (p for trend <0.001). Multimorbid people (≥2 chronic diseases) remained the highest users over the years, with 43.3% and 30.6% of them being users in 2000 and 2016, respectively. Conversely, the proportion of users increased for other hypnotics, particularly for trazodone and quetiapine, rising from 5.4% to 8.4% (p < 0.001), and especially among multimorbid individuals (from 7.4% to 11.6%). Conclusion: Older adults used benzodiazepines less frequently but quetiapine and trazodone more frequently in recent years. The use of these medications, particularly in multimorbid people at risk of adverse events, must be addressed.