BACKGROUND: The widespread prescribing of benzodiazepine receptor agonists (BZRA) is a public health problem worldwide. However, few studies have explored the relationship between the number of BZRA prescriptions and social determinants of health (SDH). Furthermore, to our knowledge, no reports have investigated the relationship between BZRA prescribing and social capital. Therefore, our objective was to conduct a prefecture-level ecological study focused on the number of BZRA prescriptions and SDH, including social capital. METHODS: We drew data for the number of BZRA prescriptions for April 2018 to March 2019 from The National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. For the SDH, we obtained data on the relative poverty rate, Gini coefficient, unemployment rate, post-high school education advancement rate, number of single-parent households per 1,000 households, single-person household rate, and social capital scores from publicly available internet sources and previous report. We calculated the standardized claim ratio (SCR) for the number of BZRA prescriptions by prefecture. We then investigated the relationship between the SCR for BZRA and SDH through an ecological study using Spearman's rank correlation coefficients and multivariate regression analysis. RESULTS: The relative poverty rate, Gini coefficient, unemployment rate, number of single-parent households per 1,000 households, and single-person household rate were positively and significantly correlated with the SCR for BZRA. In addition, the social participation domain of social capital was significantly negatively correlated with the SCR for BZRA. In the multivariate analysis, the relative poverty rate and single-person household rate remained independently associated with higher BZRA utilization. However, the association between social participation and BZRA use was no longer significant after adjusting for these socioeconomic factors. CONCLUSIONS: This ecological study suggests that regional BZRA prescribing is associated with socioeconomic deprivation and household instability. While further individual-level research is needed to clarify the underlying mechanisms, our findings highlight the importance of addressing social determinants to manage regional disparities in BZRA use.
Zukeran et al. (2026) studied this question.