Socioeconomic status and prescribing of ADHD medications: a study of ICB-level data in England

BACKGROUND: Little is known about the impact of healthcare structural changes and socioeconomic indices, such as deprivation, mental health needs, and inequalities, on attention-deficit hyperactivity disorder (ADHD) medication prescribing across different regions in England. OBJECTIVE: The objective was to examine trends in ADHD medication prescribing and explore their association with socioeconomic factors. METHODS: A population-level observational study was conducted using the English Prescribing Dataset (from April 2019 to March 2024) published by the NHS Business Services Authority and the OpenPrescribing platform (Bennett Institute for Applied Data Science, University of Oxford). The study examined trends in five licensed ADHD medications at national, regional and integrated care board (ICB) levels, using linear regression and a generalised additive model to explore the association between socioeconomic factors and prescription rates. FINDINGS: The prescriptions increased significantly from 25.17 items per 1000 population in 2019/20 (pre-COVID-19) to 41.55 items in 2023/24 (post-COVID-19), with an average annual increase of 18% nationally. Methylphenidate remained the most prescribed medication, while lisdexamfetamine showed the highest growth rate (55% annually, 95% CI 40% to 71%, p<0.01). Significant regional variations were observed, with London experiencing the highest annual increase (28%), and the Northeast and Yorkshire the lowest (13%). Socioeconomic factors, including ethnicity and deprivation, were significantly associated with ADHD prescription rates (p<0.05). CONCLUSIONS: Findings reveal a substantial increase in ADHD medication use in England following the COVID-19 pandemic, with significant variations at regional and ICB levels and complex socioeconomic influences. CLINICAL IMPLICATIONS: Findings highlight the need to understand and address drivers of disparities in ADHD care while optimising management strategies across diverse populations.