Are there differences in the prescription of fall risk-increasing drugs between ethnic groups in Norway? A cross-sectional study

Abstract

Background Benzodiazepines and Z-drugs (BZD-Z) are fall risk-increasing drugs that have been associated with an increased risk of hip fracture (1). Hip fracture is a significant public health issue, with incidence rates varying greatly between ethnicities. Norway has one of the highest incidence rates of hip fractures (2,3). It is unknown if the prescription of BZD-Z differs between ethnic groups in Norway, therefore, this study aims to investigate if there are differences in the prescription of BZD-Z between different ethnic groups in Norway. It is also aimed to describe the rate of hip fractures in BZD-Z users compared to BZD-Z non-users. Methods The study population comprised all individuals in the Norwegian population who participated in the Population and Housing Census 2001, aged between 50 and 89 during three time-points, 2005, 2010, and 2015. As a rough proxy of ethnicity, background regions were divided into three geographical regions, Norway, South Asia, and the Middle East. Chi-square test (X2) and gender-stratified logistic regression analysis, adjusted for age, were used to assess the relationship between BZD-Z usage and different ethnicities and describe the relationship between BZD-Z usage and hip fractures. Results In this Norwegian register-based study, it was found that immigrant women were less likely to be prescribed BZD-Z than Norwegian women. In 2015, females from the Middle East had 24% lower BZD-Z prescription prevalence than Norwegian females. While the prevalence of use was 51% lower in females from South Asia than in Norwegian females. However, males from the Middle East had a higher BZD-Z prescription prevalence than males from Norway and South Asia. In 2015, the prevalence of use was 19% higher in males from the Middle East than in Norwegian males. Prevalence of use was 17% lower in males from South Asia than Norwegian males. In addition, it was found that BZD-Z users were more likely to sustain hip fractures compared to non-users (adjusted OR=1.43; 95% CI= 1.36-1.50). Conclusion Lower rate of prescriptions of BZD-Z was found in immigrant women groups compared to Norwegian women. However, males from the Middle East were prescribed the highest BZD-Z prescriptions compared to males from Norway and South Asia.