title: Australian population trends and disparities in cholinesterase inhibitor use, 2003 to 2010.
abstract: BACKGROUND
  The Australian Pharmaceutical Benefits Scheme (PBS) first subsidized cholinesterase inhibitors (CEIs) for Alzheimer's disease in 2001, introducing a novel therapy for a previously untreatable common condition. This study aims to determine Australian rates of CEI use and to assess equality of access to treatment based on socioeconomic status and geographic remoteness.
  
  
  METHODS
  Pharmaceutical claims records were used to identify all Australians prescribed CEIs between January 2003 and December 2010. Age-standardized and sex-adjusted index prescription rates were derived using the total Australian population as the denominator to examine temporal trends and the impacts of socioeconomic and geographic disadvantage on CEI index prescription rates.
  
  
  RESULTS
  Index prescription rates peaked in 2004 at 92.5 per 100,000 person-years, declining to between 70.2 and 73.5 for years 2006 to 2010. Rates were highest in the 85- to 89-year age group and 2.6-fold higher in the least socioeconomic disadvantaged population when compared with the most disadvantaged population. In major cities in Australia, index prescription rates were 1.4 to 1.7 times greater compared with remote areas.
  
  
  CONCLUSIONS
  Increasing geographic remoteness and socioeconomic disadvantage are associated with lower CEI index prescription rates, indicating inequities in the management of Alzheimer's disease in Australia.
authors.affiliation: Centre for Population Health Research, Curtin University, Western Australia, Perth, Australia. Electronic address: r.zilkens@curtin.edu.au.
authors.forename: Renate R
authors.initials: RR
authors.lastname: Zilkens
authors.affiliation: Centre for Population Health Research, Curtin University, Western Australia, Perth, Australia; School of Surgery, University of Western Australia, Western Australia, Perth, Australia.
authors.forename: Janine
authors.initials: J
authors.lastname: Duke
authors.affiliation: Curtin Health Innovation Research Institute, Faculty of Health Science, Curtin University, Perth,Western Australia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Horner
authors.affiliation: Centre for Population Health Research, Curtin University, Western Australia, Perth, Australia.
authors.forename: James B
authors.initials: JB
authors.lastname: Semmens
authors.affiliation: School of Medicine & Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: David G
authors.initials: DG
authors.lastname: Bruce
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D018697:Nootropic Agents / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D012424:Rural Population / Q000706:statistics & numerical data / Q000639:trends; D012737:Sex Factors; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data / Q000639:trends; D055815:Young Adult
chemical_list: D002800:Cholinesterase Inhibitors; D018697:Nootropic Agents
keywords: Age-specific rates; Alzheimer's disease; Cholinesterase inhibitors; Drug prescriptions; Epidemiology; Remoteness; Retrospective studies; Socioeconomic disadvantage