Observational cohort study: deprivation and access to anti-dementia drugs in the UK

Cooper, Claudia; Lodwick, R; Walters, Kate; Raine, Rosalind; Manthorpe, Jill; Iliffe, Steve; Petersen, Irene

doi:10.1093/ageing/afv154

Cited by 68 publications

(80 citation statements)

References 19 publications

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“…Sixth, the international literature emphasizes the relationship between AD and high costs 25 , which could lead to less Another important finding of the present study was the clear disparity in the distribution of medications in Brazil, a result that has also been confirmed by other international studies such as one conducted in Australia, which found that geographic isolation and lower socioeconomic conditions were associated with lower rates of prescriptions of cholinesterase inhibitors 27 , and another in the United Kingdom, which found that rates of prescriptions of cholinesterase inhibitors diminished as inequality and financial needs increased 28 .…”

supporting

confidence: 83%

Trends and disparities in the use of cholinesterase inhibitors to treat Alzheimer’s disease dispensed by the Brazilian public health system – 2008 to 2014: a nation-wide analysis

Moraes

Souza

Lucchetti

et al. 2018

Arq. Neuro-Psiquiatr.

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In light of the high cost of dementia treatment, there is legislation authorizing free distribution of cholinesterase inhibitors to those suffering from Alzheimer’s disease in Brazil. However, the existence of this free distribution does not guarantee adequate distribution. Objectives The present study aimed to investigate the trends of prescriptions and the coverage of Alzheimer’s disease treatment using cholinesterase inhibitors from public pharmacies dispensing high-cost drugs in Brazil. Methods This was a retrospective study that collected data from the Brazilian public Unified Health System. All cholinesterase inhibitors distributed at no cost to Brazilians during the year 2014, as well as the estimated number and percentages of patients who used these medications, were evaluated and compared to data from the year 2008. Results Our estimates indicated that 9.7% of the population having dementia syndromes used cholinesterase inhibitors, as well as 16.1% of those with Alzheimer’s disease in Brazil. A clear disparity was noted between the use and distribution of cholinesterase inhibitors, depending on the region in which they were found. Over time, an increase in the distribution of cholinesterase inhibitors has been noted. In 2008, that use was 12.0% whereas, in 2014, it was 16.1%, an increase of 34% in six years. Conclusion It was estimated that 16.1% of patients with Alzheimer’s disease in Brazil use cholinesterase inhibitors. These values have increased and, in spite of not being satisfactory, they indicate a potential for improvement. However, there is still a significant disparity among the regions.

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supporting

confidence: 83%

Trends and disparities in the use of cholinesterase inhibitors to treat Alzheimer’s disease dispensed by the Brazilian public health system – 2008 to 2014: a nation-wide analysis

Moraes

Souza

Lucchetti

et al. 2018

Arq. Neuro-Psiquiatr.

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“…Lower levels of education and worse physical health, which are strongly linked to deprivation, are associated with a greater dementia risk [2, 3]. Among people with dementia those from more deprived areas, women and older people are relatively less likely to receive anti-dementia drugs [18]. We aimed to investigate whether there are also social inequalities in physical preventative healthcare provision and psychotropic drug prescribing among people with dementia, and to compare these outcomes in people with and without dementia.…”

Section: Introductionmentioning

confidence: 99%

Inequalities in receipt of mental and physical healthcare in people with dementia in the UK

Cooper¹,

Lodwick

Walters

et al. 2016

Age Ageing

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BackgroundUK Dementia Strategies prioritise fair access to mental and physical healthcare. We investigated whether there are inequalities by deprivation or gender in healthcare received by people with dementia, and compared healthcare received by people with and without dementia.Methodswe investigated primary care records of 68,061 community dwelling dementia patients and 259,337 people without dementia (2002–13). We tested hypotheses that people with dementia from more deprived areas, and who are women receive more psychotropic medication, fewer surgery consultations, are less likely to receive annual blood pressure, weight monitoring and an annual review, compared with those from less deprived areas and men.Resultsonly half of people with dementia received a documented annual review. Deprivation was not associated with healthcare received. Compared to men with dementia, women with dementia had lower rates of surgery consultations (adjusted incidence rate ratio (IRR) 0.90, 95% CI 0.90–0.91), of annual blood pressure monitoring (adjusted IRR 0.96, 95% CI 0.95–0.97) and of annual weight monitoring (adjusted IRR 0.91, 95% CI 0.90–0.93). Men with dementia were less likely to be taking psychotropic medication than women with dementia. People with dementia had fewer surgery consultations and were less likely to have their weight and blood pressure monitored at least annually, compared to the non-dementia group.Conclusionspeople with dementia, in particular women, appear to receive less primary healthcare, but take more psychotropic medication that may negatively impact their physical health. Reducing these inequalities and improving access of people with dementia to preventative healthcare could improve the health of people with dementia.

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“…Since the indices for area deprivation have been widely associated with inequalities in access to care and services, people with dementia living in deprived areas might have limited support from local health and social care systems. Recent analyses of UK primary care data suggested that people with dementia in least deprived areas were 25% more likely to be prescribed antidementia drugs such as cholinesterase inhibitors and memantine than the most deprived but did not find any variation in receipt of healthcare and psychotropic medication across deprivation levels . On the other hand, Dementia Atlas, an interactive website developed to monitor indicators for primary, secondary, and tertiary care in England, reveals disparity of care and different completion rates of the annual care review across areas .…”

Section: Discussionmentioning

confidence: 99%

Inequalities in living well with dementia—The impact of deprivation on well‐being, quality of life and life satisfaction: Results from the improving the experience of dementia and enhancing active life study

Clare

Jones

et al. 2018

Int J Geriat Psychiatry

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Objectives Area level factors, such as deprivation and urban/rural settings, have been associated with variation in local resources and services and health inequality in later life. The aim of this study is to investigate the potential impact of deprivation and urban/rural areas on capability to live well with dementia and to examine whether availability of informal carers modified the associations. Methods The analysis was based on a large cohort study of 1547 community‐dwelling people with dementia across Great Britain. Quality of life, life satisfaction, and well‐being were measured as indices of “living well.” Multivariate modelling was used to investigate differences in living well measures across deprivation quintiles and urban/rural areas adjusting for sociodemographic factors and number of comorbidities and stratifying by three groups: those living with a carer, those with a noncoresident carer and those without a carer. Results Negative dose‐response relationships between deprivation and measures of quality of life (−2.12; 95% CI: −3.52, −0.73), life satisfaction (−1.27; 95% CI: −2.70, 0.16), and well‐being (−5.24; 95% CI: −10.11, −0.36) were found in participants living with a carer. The associations were less clear in those with a noncoresident carer and those without a carer but these two groups generally reported lower scores on living well indicators than participants living with a carer. There was no urban/rural difference. Conclusions The findings suggest inequalities in living well with dementia according to levels of deprivation. Additional resources are needed to improve postdiagnostic care in highly deprived areas and support those who have no informal carer.

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Observational cohort study: deprivation and access to anti-dementia drugs in the UK

Cited by 68 publications

References 19 publications

Trends and disparities in the use of cholinesterase inhibitors to treat Alzheimer’s disease dispensed by the Brazilian public health system – 2008 to 2014: a nation-wide analysis

Trends and disparities in the use of cholinesterase inhibitors to treat Alzheimer’s disease dispensed by the Brazilian public health system – 2008 to 2014: a nation-wide analysis

Inequalities in receipt of mental and physical healthcare in people with dementia in the UK

Inequalities in living well with dementia—The impact of deprivation on well‐being, quality of life and life satisfaction: Results from the improving the experience of dementia and enhancing active life study

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