All in this together? How socioeconomic deprivation affects dementia treatment

aaClaudia Cooper is a senior lecturer at University College London, specialising in older people with dementia and mental health issues, and an honorary consultant old age psychiatrist with Camden and Islington NHS Foundation Trust. In this blog, she discusses her recent Age & Ageing paper on dementia and socioeconomic deprivation.

Over 800,000 people in the UK have dementia and numbers are growing as people live longer. There is no cure but drug treatments can help, for example by slowing memory loss among some people. The UK National Dementia Strategies made fair access to these treatments a priority.  We wanted to find out how likely it is that people living with dementia get these drugs.

For this study, we looked at primary care records from 6% of the UK population, including 75,000 people with a recorded diagnosis of dementia (including non-specific dementia, Alzheimer’s disease and vascular dementia) or a prescription for anti-dementia medication between 2002 and 2013.

We found that people in England from least deprived areas (generally the richest) were 25% more likely to be started on ‘anti-dementia’ drugs than people in the most deprived areas. This did not change over time despite the National Dementia Strategy and other government policies. By contrast, in Scotland, deprivation in the area where people lived did not affect whether they got this treatment.

We speculated that these inequalities may have been caused by wealthier patients being better at negotiating health care systems, and asking more frequently for specific treatments. Patients with higher levels of socioeconomic deprivation may have higher average morbidity, attend relatively under-resourced practices, and be less able to attend appointments, especially in rural areas.

It is striking that people with dementia living in more deprived areas get less treatment in England but not Scotland. Scotland spends more on health than England, and the countries have different health policies. One reason for this difference in dementia prescribing may be that from 2006 to 2009, NICE restricted prescribing of these drugs  to people with moderate dementia but the Scottish Intercollegiate Guidelines Network did not. We think that people from more affluent areas may also be more likely to ask for and get treatments not endorsed by guidelines. In addition, younger people with dementia  were more likely to be treated than older people, and men were more likely to be treated than women.

More research is needed to help ensure that dementia treatment in England is fair and meets equalities targets. We should be aware that policies to restrict treatment availability probably affect people in deprived areas most and make sure that changes benefit everyone.

This work was supported by The  Dunhill Medical Trust [grant number  R296/0513].

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