Differences in Psychotropic Drug Prescribing Between Ethnic Groups of People with Dementia in the United Kingdom

Abstract

Purpose

To test hypotheses that minority ethnic people with dementia in the UK receive fewer anti-dementia drugs and more psychotropic and anticholinergic drugs associated with harms.

Patients and Methods

We analyzed UK primary care electronic health records from The Health Improvement Network (THIN) database (2014–2016), comparing psychotropic drug prescribing initiation and duration between people with dementia from White, Black, and Asian ethnic groups. We repeated analyses in people (aged 50+) without dementia, to explore whether any differences found reflected prescribing patterns in the general older population, or were specific to dementia.

Results

We included 53,718 people with and 1,648,889 people without dementia. Among people with dementia, compared to White ethnic groups, Asian people were less likely to be prescribed anti-dementia drugs when they were potentially indicated (adjusted prevalence rate ratio 0.86 (95% Confidence Interval 0.76–0.98)), and received them for on average 15 days/year less. Compared to White groups, Asian and Black individuals with dementia were no more likely to take an antipsychotic drug, but those that had were prescribed them for 17 and 27 days/year more, respectively (190.8 (179.6–199.1) and 200.7 (191.1–206.5) days). Black people were less likely to be prescribed anxiolytics/hypnotics (0.60 (0.44–0.8)), but the duration these drugs were prescribed was similar across ethnic groups. Asian people were more likely to be prescribed anticholinergic drugs (1.43 (1.19–1.73)), in analyses unadjusted for cardiovascular comorbidities. Among people without dementia, those in the Asian and Black ethnic groups were less likely to be prescribed psychotropic drugs, relative to people from White groups.

Conclusion

Among people with dementia, Asian groups received less potentially beneficial symptomatic treatments, and Asian and Black groups were prescribed antipsychotic drugs for longer than White ethnic groups. Our findings may indicate care inequalities.

Keywords:

• ethnicity
• prevalence rate ratio
• medication
• prescription duration

Acknowledgment

We would like to thank our lay advisors.

Abbreviations

THIN, The Health Improvement Network; UK, United Kingdom.

Data Sharing Statement

Authors that signed a data usage agreement for the dataset had access to the data for this study and have on-going access. The dataset consists of pseudonymized primary care records that are only accessible via password-protected systems to authorized users.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

Mary Elizabeth Jones reports grants from Dunhill Medical Trust, during the conduct of the study; and has been offered and accepted a position at GlaxoSmithKline, a pharmaceutical company, taken up after this paper’s submission. The company does not manufacture drugs addressed in this submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

This work was funded by The Dunhill Medical Trust (grant number R530/1116).