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Oral antipsychotic prescribing and association with neighbourhood-level socioeconomic status: analysis of time trend of routine primary care data in England, 2011–2016

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Abstract

Background

Increasing rates of antipsychotic prescribing have been reported previously, particularly for second-generation antipsychotics (SGAs), which are generally better tolerated than the older first-generation antipsychotics (FGAs). Prescribers, however, may exert bias, favouring prescriptions of novel drugs for patients of higher socioeconomic status (SES). We aimed to examine time trends in: (1) prescriptions of oral FGAs vs. SGAs and (2) associations between antipsychotic prescriptions and neighbourhood-level SES in England between 2011 and 2016.

Methods

We used publicly available data for prescriptions made in primary care and linked general practices’ postcodes with the Index of Multiple Deprivation (IMD) as a measure for neighbourhood-level SES. Absolute numbers of antipsychotic prescriptions were calculated. Linear regression analysis was used to examine the association of SGA vs. FGA prescription pattern with time and with SES.

Results

A total of 27,486,000 oral antipsychotics were prescribed during the study period, mostly SGAs (n = 21,700,000; 78.9%). There was a significant increase in the ratio of SGA/FGA prescriptions over time (β = 0.376, 95% CI 0.277–0.464, P < 0.001). Individual FGAs were increasingly prescribed in areas of lower SES and the converse for SGAs except amisulpride. During the study period, a significantly larger proportion of total SGA prescriptions relative to total FGAs were made in areas of higher SES (β = 0.182, 95% CI 0.117–0.249, P < 0.001).

Conclusion

Prescriptions of antipsychotics continue to rise overall, with SGAs taking preference especially in areas of higher SES. The pattern of antipsychotic prescription favouring people in areas of lower social deprivation carries implications on inequalities even among sub-groups of people with mental disorders.

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Funding

No specific funding was available for this study.

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Author notes

  1. Kurt Buhagiar and Mustafa Ghafouri contributed equally to this work.

Authors and Affiliations

  1. Research Department, East London NHS Foundation Trust, London, UK

    Kurt Buhagiar

  2. European Big Data Laboratory, Hitachi Global Centre for Social Innovation, London, UK

    Mustafa Ghafouri

  3. Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK

    Mrinalini Dey

Authors
  1. Kurt Buhagiar
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  2. Mustafa Ghafouri
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  3. Mrinalini Dey
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Contributions

KB and MG conceived the original idea for the study and collected, analysed and interpreted the data. KB wrote the original draft of the manuscript. MD contributed to data interpretation and later drafts of the manuscript. All authors read and approved the final version of the manuscript.

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Correspondence to Kurt Buhagiar.

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The author(s) declare that they have no conflict of interests

Ethics approval

Ethical approval was not required for the study as it is based on publicly available data sources and no human participants were involved.

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Buhagiar, K., Ghafouri, M. & Dey, M. Oral antipsychotic prescribing and association with neighbourhood-level socioeconomic status: analysis of time trend of routine primary care data in England, 2011–2016. Soc Psychiatry Psychiatr Epidemiol 55, 165–173 (2020). https://doi.org/10.1007/s00127-019-01793-9

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