The influence of prescriber and patient gender on the prescription of benzodiazepines: evidence for stereotypes and biases?

Purpose: Benzodiazepines are commonly prescribed globally. We hypothesize that gender stereotypes influence benzodiazepine prescriptions insofar as male prescribers are more likely to prescribe benzodiazepines to female patients. Methods: Our nationwide cohort study included 2,127,441 patients with a psychiatric disorder (ICD-9 codes 290–319) and 38,932 prescribers as part of the Taiwan National Health Insurance Research Database (1997–2013). We evaluated the effects of patient and prescriber gender on the proportion of patients prescribed benzodiazepines and the cumulative dosage of benzodiazepine prescription (mg) using generalized estimating equation and general linear models. Results: The proportion of patients prescribed benzodiazepines was higher among male (vs. female) prescribers [odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.05–1.07] and among female (vs. male) patients (OR = 1.08, 95% CI = 1.08–1.09). Similarly, male prescriber gender (β = 10,292.2, SE = 1265.5, p < 0.001) and female patient gender (β = 7913.7, SE = 627.1, p < 0.001) predicted higher cumulative dosages of benzodiazepine prescription. Mean cumulative dosage was highest among female patients seen by male prescribers (β = 4283.7, SE = 717.6, p < 0.001). The results were consistent in sensitivity analyses of patients with anxiety disorder (n = 1,632,363), major depression (n = 1,122,796), or chronic administration (n = 1,981,819), and prescribers with psychiatrists (n = 1276), and non-psychiatrists (n = 33,268). Conclusions: Male prescribers were more likely to prescribe benzodiazepines to female patients relative to male patients. This gender bias in prescription is significant and warrants careful attention at point of care. We hypothesize that internalized societal biases and stereotypes affect benzodiazepine prescribing behaviour.