title: Exposure to benzodiazepines (anxiolytics, hypnotics and related drugs) in seven European electronic healthcare databases: a cross-national descriptive study from the PROTECT-EU Project.
abstract: OBJECTIVE
  Studies on drug utilization usually do not allow direct cross-national comparisons because of differences in the respective applied methods. This study aimed to compare time trends in BZDs prescribing by applying a common protocol and analyses plan in seven European electronic healthcare databases.
  
  
  METHODS
  Crude and standardized prevalence rates of drug prescribing from 2001-2009 were calculated in databases from Spain, United Kingdon (UK), The Netherlands, Germany and Denmark. Prevalence was stratified by age, sex, BZD type [(using ATC codes), i.e. BZD-anxiolytics BZD-hypnotics, BZD-related drugs and clomethiazole], indication and number of prescription.
  
  
  RESULTS
  Crude prevalence rates of BZDs prescribing ranged from 570 to 1700 per 10,000 person-years over the study period. Standardization by age and sex did not substantially change the differences. Standardized prevalence rates increased in the Spanish (+13%) and UK databases (+2% and +8%) over the study period, while they decreased in the Dutch databases (-4% and -22%), the German (-12%) and Danish (-26%) database. Prevalence of anxiolytics outweighed that of hypnotics in the Spanish, Dutch and Bavarian databases, but the reverse was shown in the UK and Danish databases. Prevalence rates consistently increased with age and were two-fold higher in women than in men in all databases. A median of 18% of users received 10 or more prescriptions in 2008.
  
  
  CONCLUSIONS
  Although similar methods were applied, the prevalence of BZD prescribing varied considerably across different populations. Clinical factors related to BZDs and characteristics of the databases may explain these differences.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain.
authors.forename: Consuelo
authors.initials: C
authors.lastname: Huerta
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.
authors.forename: Victoria
authors.initials: V
authors.lastname: Abbing-Karahagopian
authors.affiliation: Pharmacology Unit, Department of Biomedical Sciences II, School of Medicine and Health Sciences, University of Alcalá, Madrid, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Requena
authors.affiliation: Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Oliva
authors.affiliation: European Medicines Agency (EMA), London, UK.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Alvarez
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.|Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Helga
authors.initials: H
authors.lastname: Gardarsdottir
authors.affiliation: Merck KGaA, Geneva, Switzerland.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Miret
authors.affiliation: Division Clinical Pharmacy and Epidemiology, University of Basel, Switzerland.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Schneider
authors.affiliation: Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Gil
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Souverein
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.
authors.forename: Marie L
authors.initials: ML
authors.lastname: De Bruin
authors.affiliation: European Medicines Agency (EMA), London, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Slattery
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.
authors.forename: Mark C H
authors.initials: MC
authors.lastname: De Groot
authors.affiliation: National Institute for Health Data and Disease Control, Copenhagen, Denmark.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Hesse
authors.affiliation: Institute for Medical Information Sciences, Epidemiology, and Biometry, Ludwig-Maximilians-Universitaet München, Munich, Germany.
authors.forename: Marietta
authors.initials: M
authors.lastname: Rottenkolber
authors.affiliation: Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.|Philipp Klee-Institute for Clinical Pharmacology, HELIOS Clinic Wuppertal, Wuppertal, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Schmiedl
authors.affiliation: Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Montero
authors.affiliation: Epidemiology, Pfizer Ltd, Tadworth, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bate
authors.affiliation: Spanish Center for Pharmacoepidemiological Research (CEIFE), Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Ruigomez
authors.affiliation: Spanish Center for Pharmacoepidemiological Research (CEIFE), Madrid, Spain.
authors.forename: Luis Alberto
authors.initials: LA
authors.lastname: García-Rodríguez
authors.affiliation: AstraZeneca R&D, Mölndal, Sweden.
authors.forename: Saga
authors.initials: S
authors.lastname: Johansson
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.|MRC Epidemiology Resource Centre, Southampton General Hospital, Southampton, UK.|School CAPHRI, Maastricht University, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: de Vries
authors.affiliation: Quantitative Safety and Epidemiology, Novartis Pharma AG, Basel, Switzerland.
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Schlienger
authors.affiliation: Epidemiology, Pfizer Research & Development, New York, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Reynolds
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.|University Medical Center Utrecht (UMCU), Julius Center for Health Sciences and Primary Care, The Netherlands.
authors.forename: Olaf H
authors.initials: OH
authors.lastname: Klungel
authors.affiliation: Pharmacology Unit, Department of Biomedical Sciences II, School of Medicine and Health Sciences, University of Alcalá, Madrid, Spain.|Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Madrid, Spain.
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: de Abajo
mesh_terms: D000367:Age Factors; D014151:Anti-Anxiety Agents; D001569:Benzodiazepines; D016208:Databases, Factual; D003695:Delivery of Health Care; D003718:Denmark; D005260:Female; D005858:Germany; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D009426:Netherlands; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012737:Sex Factors; D013030:Spain
chemical_list: D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines
keywords: anxiolytics; benzodiazepines; descriptive; healthcare databases; hypnotics; pharmacoepidemiology