We calculated the prevalence of benzodiazepine and/or Z-drug prescription by dividing the number of persons with at least one prescription of benzodiazepines and/or Z-drugs in 2018 by the total number of persons ≥18 years insured by the Helsana Group. The prevalences were also calculated by age and sex. Additionally, we examined the prevalence of individuals with drug prescription extrapolated for the adult Swiss population. For the extrapolation, we used census data provided by the Swiss Federal Office of Statistics. We could test the applicability and representativeness of our data to the adult Swiss population by a direct comparison between the raw and extrapolated results. Sex, age and canton of residence were adjusted through the procedure of extrapolation.

Patient characteristics of “benzodiazepine/Z-drug user” and “benzodiazepine/Z-Drug non-user” were compared by Fisher’s exact test (dichotomous characteristics), chi-squared test (>2 characteristics), and Kruskal–Wallis test (continuous characteristics). Furthermore, we analyzed the number of prescriptions and type of provider in the following subsamples: “benzodiazepine user only” the group “Z-drug user only” and “benzodiazepines and/or Z-drug user only”. As the last step, we provided group comparisons between patients with a prescription for a short-acting and a long-acting benzodiazepine.

Finally, logistic regression models were performed to estimate the association between benzodiazepine and Z-drug use and adverse health care outcomes. The outcomes included hospitalization in acute care, hospitalization in psychiatry, admission in a rehabilitation facility, and admission in a nursing home within 2018. The logistic regression models were controlled for age groups (18–25, 25–35, 35–45, 55–65, 65–74 (reference group), 75–85, ≥85), gender (male (reference group) and female), insurance model (managed care or standard model (reference group)), type of annual deductible (high (reference group) or low deductible), residential area (rural or urban (reference group)), language region (German (reference group), French, Italian) and the number of comorbid conditions (no comorbid conditions as the reference group). We provided our estimations as odds ratios (ORs) with a confidence interval of 95% (CIs). For all analyses, the R version 3.6.1 (R Development Core Team 2019) was used. Statistical significance was defined for a p-value <0.05.

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