Use of a high-volume prescription database to explore health inequalities in England: assessing impacts of social deprivation and temperature on the prescription volume of medicines

Aim: Social inequalities are widened by climate change, which increases extreme temperature events that disproportionally affect the most vulnerable people. While the diseases impacted have been reviewed in the literature, how this reflects upon pharmaceutical consumption remains unknown. We assess that effect on a panel of the most prescribed drug classes in terms of volume in the National Health Service (NHS) database. Subject and methods: A retrospective econometric analysis of NHS prescription data was carried out, focusing on antibiotics, antidepressants and bronchodilators (drugs associated to priority diseases in addition to being among the most prescribed ones) between 2011 and 2018. Data linkage enabled prescriptions to be related to the Index of Multiple Deprivation (IMD), disability adjusted life-years (DALYs) and temperature data. The analysis was then undertaken at lower layer super output areas (LSOAs) level, using fixed-effect negative binomial regression models. Results: Our results show that prescription rates were higher across the most deprived LSOAs, even after adjusting for the associated disease DALYs. In addition, prescription volume also progressively increased under colder temperatures below 15 °C, with an exacerbated effect in the most deprived areas. Conclusion: Therefore, health inequalities in England affect prescription volumes, with higher levels in the most deprived areas which are not fully explained by morbidity differences. Lowest temperature conditions appear to intensify vulnerabilities while hot temperatures do not increase these differences in terms of prescriptions. Populations residing in the most deprived LSOAs could be more sensitive to environmental variables, leading to higher consumption of medicine under cold temperature and increased air pollution.