Dispensing data exposes health inequalities in England

A UK study has used dispensing data to understand how medicine use in England changed during and after the COVID-19 pandemic, and exposed stark differences in medication use across ethnic and socioeconomic groups.

Researchers from the University of Liverpool and the BHF Data Science Centre at Health Data Research UK analysed the dispensing of around 5.8 million medicines to more than 52 million people living in England, publishing their results in the journal Nature Health.

Among the findings were that, by age 40, nearly twice as many medicines were dispensed to people in the most deprived groups as those in the least deprived groups, particularly for gastrointestinal, cardiovascular, central nervous system, nutrition and blood, and musculoskeletal conditions, and they started taking them much earlier in life. That raises serious questions about over-medicalisation, increased risk of harm from side effects, and the root causes of poor health.

Women were dispensed more medicines than men earlier in life, particularly for mental health conditions, and dispensing was highest amongst Bangladeshi and Pakistani communities, according to the paper.

There is also evidence of an increase in polypharmacy – where people are prescribed more than five different drugs – with more than 40% of 70-year-olds in this category, while 5% of three-year-olds were on at least three medicines.

The researchers point out that around £20 billion – or 10% of the total NHS budget – is spent on medicines in the UK every year, but medicines data, patient characteristics, and medical outcomes aren't routinely linked. That makes it harder to track how medicines are used in real-world practice, how safe they are, and their value for money.

"For the first time, we can see at a national level how medicines are being used, who is taking them, and where inequalities exist," said BHF Data Science Centre associate director Prof Reecha Sofat, one of the study authors. "This insight is crucial to making prescribing more effective, equitable, and safe."

The team was tapping into de-identified data that is only available to researchers working on approved, COVID-19-related research projects under emergency data-sharing permissions that have since expired, and they are calling on the government to make such access permanent to allow this type of analysis to guide healthcare policies.

That would allow regulators such as the MHRA and guideline groups such as NICE to track safety and value in near real time, according to Sofat.

"Continued and expanded linking of medicines data from secondary and private care, over-the-counter drugs, and vaccinations would help us to fill in extra details in the future," he added.

The team has developed a medicines intelligence dashboard to help representatives from the NHS, NICE, MHRA, and researchers track outcomes and side effects across the full patient journey.

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