title: Observational cohort study: deprivation and access to anti-dementia drugs in the UK.
abstract: BACKGROUND
  UK National Dementia Strategies prioritise fair access to dementia treatments for the whole population. We investigated for the first time inequalities in NHS national dementia prescribing and how they have varied between UK countries and over time.
  
  
  METHODS
  we investigated the association between Townsend deprivation score and anti-dementia drug prescribing in 77,045 dementia patients from UK primary care records from 2002 to 2013.
  
  
  RESULTS
  we included 77,045 patients with recorded dementia diagnosis or anti-dementia drug prescription. Least deprived patients were 25% more likely to be initiated on anti-dementia drugs than the most deprived (adjusted incidence rate ratio 1.25, 95% confidence interval 1.19-1.31). This was driven by data from English practices where prescribing rates were consistently lower in more deprived patients compared with Scotland, Northern Ireland and Wales, where prescribing was not related to deprivation quintile. Compared with English practices, anti-dementia medication was prescribed more often in Northern Irish (1.81, 1.41-2.34) and less in Welsh practices (0.68, 0.55-0.82), with a trend towards more prescribing in Scottish practices (1.14, 0.98-1.32). Drug initiation rates were also higher in younger people and men.
  
  
  CONCLUSIONS
  four years after the English National Dementia Strategy, there is no evidence that the Strategy's key objective of reducing treatment inequalities is being achieved. Higher overall anti-dementia drug prescribing in Scottish and Northern Irish practices, and differing clinical guidelines in Scotland from other UK countries might explain greater equality in prescribing in these countries. Strategies to offer treatment to more deprived people with dementia in England are needed.
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Claudia
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Research Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lodwick
authors.affiliation: Research Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Walters
authors.affiliation: Department of Applied Health Research, University College London, London, UK.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Raine
authors.affiliation: Social Care Workforce Research Unit, King's College London, London, UK.
authors.forename: Jill
authors.initials: J
authors.lastname: Manthorpe
authors.affiliation: Research Department of Primary Care and Population Health, University College London, London, UK UK Dementias and Neurodegenerative Diseases Research Network, London, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
authors.affiliation: Research Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Irene
authors.initials: I
authors.lastname: Petersen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002800:Cholinesterase Inhibitors / Q000600:supply & distribution*; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D011307:Drug Prescriptions; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D006297:Health Services Accessibility / Q000639:trends*; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000639:trends*; D011204:Poverty Areas; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012307:Risk Factors; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D002800:Cholinesterase Inhibitors
keywords: cholinesterase inhibitor; dementia; healthcare disparities; older people