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Increase in anticholinergic burden in the UK from 1990 to 2015: a UK Biobank study

By Jure Mur, Simon R Cox, Riccardo E Marioni, Graciela Muniz-Terrera, Tom C Russ

Posted 18 Oct 2020
medRxiv DOI: 10.1101/2020.10.16.20213884

BackgroundThe use of prescription drugs with anticholinergic properties has been associated with multiple negative health outcomes in older people. Moreover, recent evidence suggests that associated adverse effects may occur even decades after stopping anticholinergic use. Despite the implicated importance of examining longitudinal patterns of anticholinergic prescribing for different age groups, few such data are available. MethodsWe performed an age-period-cohort analysis to study trends in anticholinergic burden between the years 1990 and 2015 utilising data from >220,000 UK Biobank participants with linked prescription data from primary care. ResultsAnticholinergic burden in the sample increased between three- and nine-fold over 25 years and was significant for both period/cohort- and age-effects across all models. When adjusted for total number of prescriptions, the effect of age reversed. Anticholinergic burden was also associated with various lifestyle- and demographic factors. ConclusionsThe increase in anticholinergic prescribing is mostly due to an increase in polypharmacy and is attributable to both ageing of participants, as well as period/cohort-related changes in prescribing practices. There is evidence for deprescribing of anticholinergic medications in older age. Further research is needed to clarify the implications of rising anticholinergic use for public health and to contextualise this rise in light of other relevant prescribing practices.

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