England’s prescribing data reveals deep inequality in medicine use

England’s medicine records expose how unevenly treatment is distributed

A new analysis of 5.8 billion medicines dispensed in England offers one of the clearest national pictures yet of how prescribing patterns diverge across income, age, sex and ethnicity. Researchers examined dispensing records covering more than 52 million people during and after the COVID-19 pandemic and found stark gaps that appear early in life and widen through adulthood.

The study, led by researchers at the BHF Data Science Center at Health Data Research UK and the University of Liverpool and published in Nature Health, argues that linking medicines data to patient characteristics can do more than describe inequality. It can also show where prescribing is becoming riskier, where care may be less consistent, and where public health systems need to respond faster.

By age 40, the deprivation gap is already severe

The headline finding is the scale of the socioeconomic divide. By age 40, nearly twice as many medicines were dispensed to people in the most deprived groups as to those in the least deprived groups. The analysis also found that people in more deprived communities began receiving medicines earlier in life.

That matters because prescribing volume is not just a measure of treatment access. It can also reflect earlier disease burden, more chronic illness, and more complicated health trajectories. In practical terms, the data suggest that poorer health is showing up sooner and requiring more pharmaceutical intervention in deprived populations.

Differences by sex and ethnicity stand out

The researchers also found notable demographic differences. Women were dispensed more medicines than men earlier in life, with particularly strong differences in medicines used for mental health conditions. Dispensing rates were highest among Bangladeshi and Pakistani communities, adding another layer to the picture of uneven health burdens and treatment pathways across England.

Those findings do not by themselves explain why the differences exist. But they do provide a more precise map of where the system may need closer investigation, whether the underlying issue is disease prevalence, barriers to preventive care, or differences in how conditions are identified and managed.

Polypharmacy is becoming more common

The study also highlights the spread of polypharmacy, typically defined here as being dispensed more than five different medicines. More than 40% of 70-year-olds fell into that category. Among children, the numbers were smaller but still notable: 5% of 3-year-olds were dispensed three or more medicines.

Polypharmacy can be clinically necessary, especially in older adults with multiple conditions. But it also raises questions about drug interactions, medication review, adherence and whether prescribing remains coordinated as patients move between services. The broader the use of multiple medicines becomes, the more important those safety checks are.

The pandemic disrupted established patterns

COVID-19 created a sharp break in the data. New dispensing dropped in 2020, but the recovery was uneven. According to the researchers, new dispensing of medicines for heart disease and diabetes later rose above prepandemic levels. Dispensing for some mental health conditions, however, dropped and remained below earlier levels.

That divergence could prove important for policymakers. It suggests the pandemic did not simply pause routine care and then allow it to resume on the same trajectory. Some areas rebounded strongly, while others appear to have changed in more lasting ways.

Why the dataset matters

The National Health Service spends around £20 billion a year on medicines, roughly 10% of its budget. Yet medicines data, patient characteristics and outcomes are not routinely linked in ways that allow the system to fully track who is receiving what, how safely it is being used, or what value it is delivering. The researchers say the linkage work developed for COVID-era research shows that this kind of joined-up analysis is now possible at national scale.

That makes the study more than a snapshot of prescribing. It is also a test case for how health systems can use administrative data to identify inequities earlier, monitor treatment trends more closely, and target medication reviews where risk is rising.

The broad message is difficult to ignore. England’s prescribing record is not neutral background data. It is a detailed account of who gets ill earlier, who accumulates medicines faster, and where the NHS may need to intervene more intelligently to improve both safety and fairness.

This article is based on reporting by Medical Xpress. Read the original article.