Influence of social deprivation on benzodiazepines dispensing among children and adolescents: A large cross-sectional population-based study in France

Abstract

Background

In Europe, children benzodiazepines consumption is not consistent with existing recommendations, especially among the most economically deprived families.

Objectives

The objective was to assess the correlation between benzodiazepines dispensing among children in primary care and the European Deprivation Index (EDI), a validated ecological deprivation index that approaches socioeconomic position.

Method

A dataset from the national reimbursement database only available for the year 2012 was used including 540,325 children in a large French region. The association between benzodiazepines dispensing and the EDI (described in deciles) was assessed with a multivariate logistic regression, including confounding and mediation factors identified and available in the database.

Results

Benzodiazepines were dispensed among 2.4% of the children. EDI was associated with the dispensing of benzodiazepines (p <0.0001), but there was some heterogeneity between the deciles.  The covariates that most influenced the probability of being dispensed benzodiazepines among the most deprived patients were the fact of benefiting from the complementary universal insurance coverage (CMU-C) and the number of consultations with a general practitioner (GP). This could be explained by the interaction between the EDI and CMU-C. CMU-C reflects more precariousness at an individual level: it favors benzodiazepines’ dispensing, mediated by the increased number of consultations with GPs.

Conclusion

Social deprivation has an influence over the dispensing of benzodiazepines to children and adolescents. This raises concern about discrepancies in mental health management according to the patients’ social background, particularly by GPs, who are mainly involved.