Study of 5.8 billion medicines dispensed in England exposes stark health inequalities

by Health Data Research UK

edited by Sadie Harley, reviewed by Robert Egan

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Scientists have revealed striking inequalities and changing trends in medicines dispensing for more than 52 million people living in England during and after the COVID-19 pandemic.

The team from the BHF Data Science Center at Health Data Research UK and the University of Liverpool say this type of analysis can offer opportunities for smarter and safer prescribing in their study published in the journal Nature Health.

Key findings:

Sharp deprivation gap: By age 40, nearly twice as many medicines were dispensed to people in the most deprived groups as to those in the least deprived groups, and they started taking them much earlier in life.

Differences by sex and ethnicity: Women were dispensed more medicines than men earlier in life, particularly for mental health conditions. Medicines dispensing was highest among Bangladeshi and Pakistani communities.

Polypharmacy is rising: More than 40% of 70-year-olds were dispensed more than five different medicines, known as polypharmacy. Among children, 5% of 3-year-olds were on three or more medicines.

Shifts after the pandemic: After a sharp drop in 2020 during the pandemic, new dispensing of medicines for heart disease and diabetes exceeded prepandemic levels. But dispensing for some conditions, such as mental health conditions, dropped and remained lower than before the pandemic.

Around £20 billion, or 10% of the NHS budget, is spent on medicines in the UK every year. But medicines data, patient characteristics and medical outcomes aren't routinely linked, so health care professionals and policymakers can't fully track how medicines are used, how safe they are or their value for money.

Linking these data at an individual level for COVID-19-related research enabled scientists to understand for the first time how medicines use changed during and after the pandemic in different groups of people.

Co-author Professor Reecha Sofat, associate director of the BHF Data Science Center at Health Data Research UK 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. It also helps ensure that the billions spent each year on medicines truly deliver value for patients and taxpayers."

Co-author Dr. Caroline Dale of the University of Liverpool said, "Medicines data give us an alternative lens on clinical care—showing us both the direct and indirect effects of COVID-19 and how health conditions are managed day to day. This research is the first step toward linking medicines with health information, including health outcomes, so we can start to understand not just what drugs are used, but how well they work in real-world practice."

The electronic health record data analyzed in this study had all direct identifiers, such as names and NHS numbers, removed before researchers accessed the data, which was then accessible only within a secure data environment hosted by NHS England. The data was accessible only to approved researchers working on approved, COVID-19-related research projects.

The research team analyzed linked electronic health records for 52.6 million people living in England from November 2019 to December 2024, covering the whole COVID-19 pandemic period and the recovery afterward. They looked for patterns in how 5.8 billion medications were dispensed in primary care to patients by characteristics including age, sex, ethnicity, geographical location and deprivation.

This research was made possible by Control of Patient Information (COPI) notices, emergency data-sharing permissions introduced during the COVID-19 pandemic that allowed linked GP and prescribing records to be accessed securely for pandemic-related research. COPI notices have since expired, meaning this type of population-wide analysis can no longer be conducted under the same legal basis.

Sofat added, "COVID-19-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.

"Continued and expanded linking of medicines data from secondary and private care, over-the-counter drugs and vaccinations would help us fill in extra details in the future. High-cost cancer drugs tend to be given through hospitals, for example."

The team has developed a dashboard to help representatives from the NHS, NICE and the MHRA, as well as researchers, track outcomes and side effects across the full patient journey.

Publication details

Reecha Sofat, Patterns of medication use across society from national primary care dispensing data, Nature Health (2026). DOI: 10.1038/s44360-026-00134-w. www.nature.com/articles/s44360-026-00134-w

Journal information: Nature Health

Key medical concepts

PolypharmacyCardiovascular DiseasesDiabetesMental DisordersVaccination

Clinical categories

Clinical pharmacologyPreventive medicineCommon illnesses & Prevention Provided by Health Data Research UK Who's behind this story?

Sadie Harley

BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries. Full profile →

Robert Egan

Bachelor's in mathematical biology, Master's in creative writing. Well-traveled with unique perspectives on science and language. Full profile →

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