Background: Previous studies have shown higher prescribing rates of certain medicines, including opioids, antibiotics, and statins, in areas of increased socio-economic deprivation. Nationwide studies systematically assessing these associations across all medicines are however lacking.
Objectives: We aimed to carry out a pan-formulary drug utilisation study of the association between medicine dispensations from community pharmacies and socio-economic deprivation.
Methods: A drug utilisation study of all medicines dispensed from community pharmacies in England between December 2021 and November 2022, was performed utilising data from the English Prescribing Dataset. For each Primary Care Practice, medicines were grouped at the British National Formulary (BNF) paragraph level (6 digits) and then linked to practice population lists from April 2022 to derive dispensing rates. These rates were mapped to 32,844 Lower Layer Super Output Areas (LSOAs). BNF paragraphs dispensed in less than 80% of LSOAs were excluded. Quasi-Poisson regression models estimated the association between Index of Multiple Deprivation (IMD) 2019 score and dispensing rates expressed as rate ratios (RRs) per five units increase in IMD score after adjusting for LSOA-level mean age, ethnicity, and gender characteristics.
Results: Of 256 paragraphs, 201 were included in the study after meeting the inclusion criteria consisting of >1 billion dispensations with a total denominator population of 56.5 million people. 155 paragraphs showed an increased dispensing rate in more deprived areas including opioid pain medications (RR 1.076, 95% CI 1.075-1.078), topical analgesics (RR 1.077, 95% CI 1.076-1.079), and antipsychotic drugs (RR 1.064, 95% CI 1.062-1.065) aligning with prior literature. In addition, associations were seen in nutrition related paragraphs, such as enteral nutrition (RR 1.062, 95% CI 1.060-1.064), symptomatic relief for gastrointestinal disorders, such as drugs for nausea and vertigo (RR 1.061, 95% CI 1.059-1.062) and cardiovascular drug classes, such as antiplatelet drugs (RR 1.037, 95% CI 1.036-1.037) and loop diuretics (RR 1.041, 95% CI 1.040-1.042). 42 paragraphs showed a decreased dispensing rate in more deprived areas including treatments for the management of skin conditions (RR 0.830, 95% CI 0.813-0.847) and drugs for arrhythmias (RR 0.975, 95% CI 0.973-0.977).
Conclusions: Increased deprivation was associated with higher utilisation for a wide range of medicine classes. Future work should seek to identify potential drivers of differential prescribing patterns to promote health equity for all.
