Journal Article

6899 The influence of socioeconomic deprivation on the pattern of melatonin prescribing practices among CYP with NDD in a NW NHS Trust

Ogundele, Michael

2024

Overview

ObjectivesSleep disorder is one of the commonest comorbidities among children and young people (CYP) with Neurodevelopmental, emotional, behavioural and Intellectual disorders (NDEBID) (Ogundele & Yemula 2022). A sizeable proportion of these CYP fail to respond to the first line recommendation of behavioural and psychological interventions. Melatonin is the commonest pharmacological agent prescribed for managing sleep problems in this group of CYP.Socioeconomic deprivation is one of the environmental factors known to predispose to various chronic conditions including NDEBID (Rakesh et al 2023). Aims and Objectives:We aimed to examine the relationship between the socioeconomic status (SES) of CYP with comorbid sleep problems and their requirement for prescribed melatonin.MethodsWe retrospectively reviewed all prescriptions for melatonin among community child health clinics (CCH) in Halton between June and October 2022 as part of local Clinical Governance audit process. The SES of each patient was estimated using the latest Index of Multiple Deprivation (IMD) scores 2019 based on their respective postcodes and corresponding Lower Super Output area (LSOA). We calculated the deciles and quintiles by dividing the England’s 32,844 LSOAs into 10 and 5 equal groups respectively. Spearman’s rank correlation coefficient was used to determine the statistical significance of the distribution of patients among different socioeconomic areas.No patient identifiable data was collected and no ethical approval was required.ResultsIn 2021, 0–15 childhood population of Halton was 24,530, corresponding to 19% of the total of the total population of 128,500 (ONS).39 patients (M/F= 29/10) aged 3 to 18 years (average of 10 years) had a total of 3760 prescription days made during the study period, at an average dose of 3mg (table 1). The average prescribed doses increased significantly with age (Rho 1, p <0.001).The proportion of the childhood population offered prescriptions was 1.4 per 1000 child’s population. The majority of the patients lived in the most deprived areas of the LA (82% lived in the most deprived 4 deciles of the IMD), and they were on relatively higher doses (figure 1).Abstract 6899 Table 1Showing age and gender distribution of patientsConclusionThe burden of NDEBID conditions is highest among CYP within the lowest SES. They also account for the largest cost of melatonin prescriptions. The cost-effectiveness of preventative measures such as prenatal, early years and school health, education and social welfare projects, as well as parenting training require further research.Abstract 6899 Figure 1Showing the distribution of patients per Decile of Socio-economic Deprivation.ReferencesOgundele MO, Yemula C. Management of sleep disorders among children and adolescents with neurodevelopmental disorders: A practical guide for clinicians. World J Clin Pediatr. 2022 Mar 15;11(3):239–252. doi: 10.5409/wjcp.v11.i3.239. PMID: 35663001; PMCID: PMC9134149.ONS Population changes: (https://www.ons.gov.uk/visualisations/censusareachanges/E06000006/).Rakesh D, Whittle S, Sheridan MA, McLaughlin KA. Childhood socioeconomic status and the pace of structural neurodevelopment: accelerated, delayed, or simply different? Trends Cogn Sci. 2023 Sep;27(9):833–851. doi: 10.1016/j.tics.2023.03.011. Epub 2023 May 11.

• Publisher: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health,BMJ Publishing Group LTD
• Subject: Age composition / Children / Comorbidity / Correlation / Correlation coefficient / Emotional behavior / Environmental factors / George Still Forum – National Paediatric ADHD Network Group / Melatonin / Neurodevelopment / Neurodevelopmental disorders / Patients / Pediatrics / Population changes / Prescriptions / Sleep / Sleep disorders / Socioeconomic factors / Socioeconomic Influences / Socioeconomic status / Socioeconomics