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Association of socioeconomic deprivation with opioid prescribing in primary care in England: a spatial analysis
  1. Magdalena Nowakowska1,2,3,
  2. Salwa S Zghebi1,4,
  3. Rosa Perisi1,2,
  4. Li-Chia Chen5,
  5. Darren M Ashcroft1,3,5,
  6. Evangelos Kontopantelis1,2
  1. 1 NIHR School for Primary Care Research; Centre for Primary Care and Health Services Research; Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
  2. 2 Division of Informatics, Imaging and Data Sciences; School of Health Sciences; Faculty of Biology, Medicine and Health; Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
  3. 3 NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
  4. 4 Division of Population Health, Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
  5. 5 Centre for Pharmacoepidemiology and Drug Safety; Division of Pharmacy and Optometry; School of Health Sciences; Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
  1. Correspondence to Magdalena Nowakowska, NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Suite 5, 5th Floor, Williamson Building, 176 Oxford Road, Manchester M13 9PL, UK; Magdalena.nowakowska{at}manchester.ac.uk

Abstract

Background The increasing trends in opioid prescribing and opioid-related deaths in England are concerning. A greater understanding of the association of deprivation with opioid prescribing is needed to guide policy responses and interventions.

Methods The 2018/2019 English national primary care prescribing data were analysed spatially. Prescribing of opioids in general practice was quantified by defined daily doses (DDD) and attributed to 32 844 lower layer super output areas (LSOAs), the geographical units representing ~1500 people. Linear regression was used to model the effect of socioeconomic deprivation (quintiles) on opioid prescribing while accounting for population demographics and the prevalence of specific health conditions. Adjusted DDD estimates were compared at each deprivation level within higher organisational areas (Clinical Commissioning Groups, CCGs).

Results In total, 624 411 164 DDDs of opioids were prescribed. LSOA-level prescribing varied between 1.7 and 121.04 DDD/1000 population/day. Prescribing in the most deprived areas in the North of England was 1.2 times higher than the national average for areas with similar deprivation levels and 3.3 times higher than the most deprived areas in London. Prescribing in the most deprived areas was on average 9.70 DDD/1000 people/day (95% CI 9.41 to 10.00) higher than the least deprived areas. Deprivation-driven disparities varied between individual CCGs. In the most unequal CCG, prescribing in the most deprived areas was twice that in the least deprived areas.

Conclusion Opioid prescribing varied substantially across England and deprivation was strongly associated with prescribing. This paper provides evidence for guiding policy interventions and allocation of resources to areas with the highest levels of opioid prescribing.

  • Prescribing
  • deprivation
  • spatial analysis
  • primary care
  • socio-economic

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Footnotes

  • Twitter Evangelos Kontopantelis @dataevan.

  • Contributors All authors contributed to the design of the study. MN prepared and analysed the data. MN wrote the manuscript and MN, SSZ, RP, LCC, DMA and EK all critically edited the manuscript. All authors approved the manuscript before submission.

  • Funding This study was funded as part of a PhD studentship from the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR) and NIHR Greater Manchester Patient Safety Translational Research Centre. The study represents independent research by the NIHR. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health and Social Care. The study funders had no role in the study design, data collection, analysis or interpretation, in the writing of the paper or in the decision to submit the paper for publication. MN had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Map disclaimer The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

  • Competing interests LCC and DMA have received funding for another study of opioid utilisation patterns from Mundipharma Research Ltd. MN, SSZ, RP, and EK have no conflict of interest to declare.

  • Patient consent for publication Not required.

  • Ethics approval This study involves analysis of aggregated, anonymous and publicly available data. No ethical approval was sought or required for this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data used in this study are publicly available from the sources cited in the manuscript.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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