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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.

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.

Authors+Show Affiliations

Research Department, East London NHS Foundation Trust, London, UK. kurt.buhagiar@nhs.net.European Big Data Laboratory, Hitachi Global Centre for Social Innovation, London, UK.Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31630215

Citation

Buhagiar, Kurt, et al. "Oral Antipsychotic Prescribing and Association With Neighbourhood-level Socioeconomic Status: Analysis of Time Trend of Routine Primary Care Data in England, 2011-2016." Social Psychiatry and Psychiatric Epidemiology, 2019.
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. 2019.
Buhagiar, K., Ghafouri, M., & Dey, M. (2019). Oral antipsychotic prescribing and association with neighbourhood-level socioeconomic status: analysis of time trend of routine primary care data in England, 2011-2016. Social Psychiatry and Psychiatric Epidemiology, doi:10.1007/s00127-019-01793-9.
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. 2019 Oct 19; PubMed PMID: 31630215.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oral antipsychotic prescribing and association with neighbourhood-level socioeconomic status: analysis of time trend of routine primary care data in England, 2011-2016. AU - Buhagiar,Kurt, AU - Ghafouri,Mustafa, AU - Dey,Mrinalini, Y1 - 2019/10/19/ PY - 2019/06/19/received PY - 2019/10/09/accepted PY - 2019/10/21/entrez PY - 2019/10/21/pubmed PY - 2019/10/21/medline KW - Antipsychotics KW - Prescribing trends KW - Primary care KW - Severe mental illness JF - Social psychiatry and psychiatric epidemiology JO - Soc Psychiatry Psychiatr Epidemiol N2 - 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. SN - 1433-9285 UR - https://www.unboundmedicine.com/medline/citation/31630215/Oral_antipsychotic_prescribing_and_association_with_neighbourhood-level_socioeconomic_status:_analysis_of_time_trend_of_routine_primary_care_data_in_England,_2011-2016 L2 - https://dx.doi.org/10.1007/s00127-019-01793-9 DB - PRIME DP - Unbound Medicine ER -