Glaucoma treatment and deprivation: time-series analysis of general practice prescribing in England

Background Despite advances in glaucoma management, topical eyedrop treatment has been paramount, with prostaglandin analogues (PGAs) being first-line agents. While late presentation is linked with deprivation, there is no recent research examining associations between deprivation and prescribing within primary care.

Aim To explore PGA prescribing in general practice over a 6-year timeline, assessing for associations with deprivation.

Design & Setting Analysis of NHS Business Services Authority data for general practice prescribing in England from April 2016-March 2022.

Method Glaucoma treatments by GP prescriber were extracted, identifying ~9.11–9.58 million prescriptions/annum. Data were linked to indices of multiple deprivation (IMD) quintiles of GP practices. Crude rates per 1,000 population were calculated using population data from NHS Digital. Time-series analyses facilitated comparison in prescribing nationally and in deprived areas. Autoregressive Integrated Moving Average (ARIMA) modelling facilitated measurement of synchrony between time-series using cross correlation.

Results PGAs and fixed combination eyedrops account for approximately two-thirds of glaucoma-related prescribing. Prescriptions per month increased slightly over a 6-year timeline, but rates per 1,000 of population reduced in 2020–21. PGA prescriptions dispensed in deprived areas is lower than all other quintiles. Cross-correlation analysis indicates a lag of ~12 months between average PGA prescribing nationally versus more deprived areas.

Conclusion The rate of PGA prescribing in primary care is substantially lower in deprived versus affluent areas, with delayed uptake of PGAs in more deprived areas of ~12 months. Further research is needed to explore reasons for this discrepancy, permitting strategies to be developed to reduce unwarranted variation.