Study of 5.8 Billion Medicines Dispensed in England Exposes Stark Health Inequalities
Key Insights
Analysis of 5.8 billion medications dispensed to 52.6 million people in England from 2019–2024 reveals a sharp deprivation gap, with nearly twice as many medicines dispensed to the most deprived groups by age 40.
Polypharmacy is rising steadily, with over 40% of 70-year-olds dispensed five or more medications and 5% of three-year-olds receiving three or more medicines.
Post-pandemic recovery in drug initiation was observed for cardiovascular and diabetes medications, while dispensing for mental health and gastrointestinal conditions remained below pre-pandemic levels.
Scientists from the University of Liverpool and the BHF Data Science Centre (search) at Health Data Research UK (search) have published the most comprehensive analysis to date of primary care medication dispensing in England, examining 5.8 billion medications dispensed to 52.6 million individuals between November 2019 and December 2024. The study, published in Nature Health, exposes stark inequalities in medicines use across deprivation, ethnicity, sex, and age groups, while also revealing how the COVID-19 (search) pandemic reshaped prescribing patterns across the country.
The research, funded by the National Institute of Health and Care Research (NIHR) and the British Heart Foundation, leveraged emergency data-sharing permissions introduced during the pandemic to link individual-level electronic health records with NHS Business Services Authority (NHSBSA) dispensing data for the first time at a national scale.
Sharp deprivation gap emerges early in life
One of the most striking findings was the magnitude of the deprivation gap in medication use. By age 40, nearly twice as many medicines were dispensed to people in the most deprived quintile compared with those in the least deprived quintile. In 2024, one million medications were dispensed to individuals aged 27 years in the most deprived Index of Multiple Deprivation (IMD) quintile, whereas this threshold was not reached in the least deprived quintile until age 42 years.
Rate ratios were twice as high in the most deprived quintile compared with the least deprived quintile from age 40 years for gastrointestinal, cardiovascular, central nervous system (CNS), nutrition and blood, and musculoskeletal chapters. The CNS chapter, dominated by treatments for mental health conditions and pain including antidepressants and analgesics, showed an acceleration from the mid-20s in more deprived groups.
"Medicines data give us an alternative lens on clinical care – showing us both the direct and indirect effects of COVID-19 (search) and how health conditions are managed day-to-day," said co-author Dr Caroline Dale of the University of Liverpool.
Sex and ethnicity differences in prescribing
Women received a higher total count of medications earlier in adult life compared with men during their 20s, 30s, and 40s, particularly CNS medications. Sertraline, a selective serotonin reuptake inhibitor (SSRI) antidepressant, was the most common medication among both men and women in their 20s and 30s; however, volumes were approximately double in women, with 4.4 million dispensations to women compared with 2.2 million in men in 2024.
In men, cardiovascular disease (CVD) medications accumulated markedly from the late 40s, with 1.6 million CVD medicine dispensations to men aged 50 years and 4.3 million to men aged 60 years in 2024. This resulted in a 1.5-fold difference between sexes by age 60 years.
Medication dispensing was highest among Bangladeshi and Pakistani ethnic groups, with rate ratios as much as 2.5 times higher by age 60 years for endocrine system and eye medications compared with the British, Irish, or any other white background group. Children from several ethnic groups had rate ratios as high as 5 for immunological products and vaccines. Rates of use for most British National Formulary (BNF) chapters were lowest among the Chinese ethnic group across all ages.
Polypharmacy rising across the population
The dominant trend in the population was receiving no medication or only one medication until age 64 years. However, polypharmacy—defined as five or more distinct medications within a three-month period—increased steadily with age and over the study period. By age 50 years, approximately 15% of the population had been dispensed five or more medications within a three-month period, increasing to 42% by age 70 years. At 70 years of age, approximately 12% were dispensed ten or more medications within a three-month period.
By December 2024, approximately 14.6% of the population had been dispensed five or more medications within a three-month period. Stratifying by deprivation showed a clear differential: half of the population in the most deprived quintile were dispensed five or more medications in their late 60s—a level not reached until the late 70s in the least deprived quintile.
Among children, while polypharmacy remained uncommon, 5% of three-year-olds were dispensed three or more medications within a three-month period, and 1% were dispensed five or more medications within the same timeframe.
Pandemic-driven shifts in prescribing patterns
The study documented several distinct patterns in incident medication use over the study period. Some BNF chapters showed ongoing decline throughout, including gastrointestinal system, CNS, musculoskeletal and joint diseases, and skin. The incident rate of CNS medicines in February 2024 was 4.1 per 1,000 person-months compared with 6.0 per 1,000 person-months in February 2020.
Other chapters—cardiovascular system, endocrine system, nutrition and blood, and anaesthesia—displayed sharp declines corresponding with the onset of the pandemic in March 2020, followed by subsequent recovery. For cardiovascular and endocrine medications, higher levels of incident dispenses were observed in the post-pandemic period, exceeding pre-pandemic levels by February 2022 for CVD medications and November 2021 for endocrine medications.
The infections chapter was dominated by antibacterials, the use of which declined and remained below pre-pandemic levels until December 2022, when a streptococcal outbreak led to increased demand for penicillin. Immunological products and vaccines displayed particularly marked declines, with dispenses showing slow recovery and remaining much lower than pre-pandemic levels by the end of the study period.
GLP-1 receptor (search) agonists and new therapies
The analysis captured the increased use of glucagon-like peptide 1 receptor agonists (GLP-1RAs), including semaglutide, tirzepatide, and liraglutide, during the pandemic recovery period. These medications, indicated for type 2 diabetes and additionally licensed for obesity treatment, coincided with guideline updates from the National Institute for Health and Care Excellence (NICE)—liraglutide in 2020, semaglutide in 2022, and tirzepatide in 2024. The dashboard revealed higher use in more deprived populations, though the authors noted this may partly reflect private access not captured in NHSBSA data.
Other changes involved direct-acting oral anticoagulants, resulting from NHS England (search) commissioning policies during the pandemic, as well as the uptake of new-to-market medications including bempedoic acid and inclisiran.
Call for permanent linked data infrastructure
The research was made possible by Control of Patient Information (COPI) notices—emergency data-sharing permissions introduced during the COVID-19 (search) pandemic. These notices have since expired, meaning this type of population-wide analysis can no longer be conducted under the same legal basis.
Professor Reecha Sofat, Associate Director of the BHF Data Science Centre (search) at Health Data Research UK (search) and NIHR Research Professor at the University of Liverpool, said: "For the first time, we can see at a national level how medicines are being used, who is taking them, and where inequalities exist. This insight is crucial to making prescribing more effective, equitable and safe."
Professor Sofat added: "COVID-19 (search)-era permissions gave us a unique opportunity to understand medicines use for the whole population. Now we need to make that access permanent – under the same secure safeguards – so regulators such as the MHRA and guideline groups such as NICE can track safety and value in near real time."
The study authors noted that while their analysis focuses on primary care medication dispensation, a full picture of England's medication use also requires secondary care data, over-the-counter drugs, high-cost medications such as biologics and cancer chemotherapy, medicines distributed through private healthcare, and vaccinations across the life course. The team has developed an interactive dashboard to help NHS representatives, NICE, MHRA, and researchers track outcomes and side effects across the full patient journey, accessible at https://bhf-dsc-hds.shinyapps.io/metrx/.