Do men in any specific region of England tend to use Viagra more? We set out to discover which town had the highest prevalence of Viagra and Sildenafil use in 2015-6, and whether there is any link between this and other data, such as health and lifestyle factors.

  • We used prescribing data from the NHS Statistical Publications Catalogue, which details all prescriptions issued in general practice settings in England.
  • We measured this against population figures and health and lifestyle statistics from the ONS.
  • Prescribing data does not include Viagra or Sildenafil prescriptions issued in private practices, or by online sellers.

What did we discover?

  • The FY postcode, which comprises Blackpool, Poulton-le-Fylde, Fleetwood and Lytham, was the postcode with the highest prevalence of sildenafil prescriptions issued in GP practices, with 82 per 1,000 males over the 12 month period we analysed.
  • The North East was the region with the highest prevalence, with 67.4 prescriptions per 1,000 males issued in primary care settings over the 12 month period.
  • Greater London was the region with the lowest prevalence (45.4 per 1,000 males) with London Eastern Central being the postcode area with the lowest prevalence.

Viagra and the NHS: a brief history

We’ve written before that Viagra is one of the fastest-selling medicines in history. Since it was launched by Pfizer in 1998, over 23 million prescriptions have been issued for the item across the globe. In 2013, the patent for Viagra held by Pfizer expired, which meant that Sildenafil could then be manufactured by other companies as a generic medicine for erectile dysfunction.

Doctors working in the NHS have always been able to issue Viagra privately; however, it can only be prescribed to patients on NHS prescriptions in certain circumstances. But the availability of the cheaper generic version has meant that, since 2014, some prescribing restrictions on Sildenafil have been removed, and more people can now get the drug on NHS prescription.

There were several reasons behind restrictions being lifted: such as to reduce the likelihood that men wishing to bypass paying private prices would instead obtain the drug illegally; and to enable more ED cases to be treated in primary care, as opposed to specialist services.

The data

The NHS releases information on the number of prescriptions issued by GP surgeries every month, on their Statistical Publications Catalogue website. Amongst other details, this information contains the type of drug, and the location of the surgery where the prescription was issued.

This enables us to see where in England prescriptions issued for Viagra and Sildenafil were at their highest and lowest per male capita.

We assessed prescribing data from November 2015 to October 2016, and split this into postcode areas. Using male population data for each area from Nomis (run by the Office for National Statistics), we attempted to calculate how many Viagra and Sildenafil prescriptions were issued per 1,000 males in each area.

We filtered out sildenafil results which were in dosage amounts to treat pulmonary arterial hypertension (PAH).

Caveats

Our data doesn’t take into account other means of prescribing these drugs, such as via private doctor surgeries or from online pharmacies. If patients in one area had a particular tendency to use private online services instead of NHS services, then this would not be reflected in the data.

It also doesn’t take into account the actual number of men being prescribed sildenafil, or the actual number of tablets being issued as part of a prescription.

For instance, in one case a single patient in one area may have obtained several prescriptions for sildenafil over the course of the year; whereas in another case, several men in a different area may have obtained one prescription each for sildenafil over the same period. In our analysis, these two situations would have the same statistical value.

In addition, each prescription is only counted once, whether it is for four tablets, eight tablets or sixteen tablets, regardless of the dosage. So our analysis is not representative of the number of tablets or dosages being issued.

The population data we used is from the latest available census information (2011), and does not take into account changes in the male population which may have occurred since.

What were the results?

Sildenafil -by -postcode _Top -10-Table (2)

  • The FY postcode (which covers Blackpool, Poulton-le-Fylde, Fleetwood and Lytham St Annes) tops the list, with the highest number of sildenafil prescriptions issued per capita (82 per 1,000 males) in GP practices.
  • NN, which covers Northampton and surrounding areas, comes in second with 77.6 prescriptions per 1,000 males; and DT (Dorchester) comes in third with 72.

Sildenafil -by -postcode _Bottom -10-Table (1)

  • The area with the fewest sildenafil prescriptions per 1,000 males was London East Central, with just 33.5.
  • Twickenham had the second fewest (37.4) and Bromley the third fewest (37.8).
  • Perhaps the most distinctive pattern we noticed was that, in the top 10 areas with the highest number of sildenafil prescriptions per capita, not one single London or South East postcode area appears.
  • However, at the other end of the table, eight of the 10 postcode areas with the fewest per capita prescriptions were in Greater London.
  • Looking at the 20 areas with the fewest numbers, 18 of these are either in or on the outskirts of Greater London.

You can see the full results table at the bottom of this page.

We also assessed the data on a region-by-region basis. Here’s what we found:

Sildenafil -by -postcode (1)

  • The North East region had the highest number of prescriptions per capita, with 67.4.
  • Yorkshire and the Humber placed second (63), and the North West third (62.5).
  • Greater London had the fewest per capita, with 45.4.

Does average income make a difference?

So why might London have a lower number of sildenafil prescriptions issued by GP practices than the rest of the country?

As we mentioned earlier, our figures do not take into account the number of prescriptions issued in private settings or online. Patients will pay more to be seen privately than they would on the NHS, and buying prescription medication from online pharmacies is typically more expensive than buying at the NHS levy rate.

London is without doubt the most affluent region in England. The gross disposable household income per head (GDHI) is the highest in the country at £22,516, according to figures published in 2013 by the ONS.

As a result, we might surmise that many men seeking treatment in London can simply afford to go private or buy their treatment online; which may go some way to explaining the higher number of NHS-issued sildenafil prescriptions in less affluent regions:

Sildenafil -prescriptions -vs -GDHI(1)

What we can see from the above chart is an almost inverse correlation between sildenafil prescriptions issued in NHS practices per capita, and GDHI. The area with the lowest GDHI, the North East, had the highest number of prescriptions issued in NHS practices per capita; and Greater London the opposite.

But to validate this assertion, we would ultimately need to know how many prescriptions for Viagra or Sildenafil were issued privately and online.

However, could GDHI be having an effect on the number of prescriptions issued in less direct ways?

Organisations such as the Urban Institute and the Joseph Rowntree Foundation have investigated the link between health and economic well being; they suggest that people living on lower incomes are more likely to have poor health and be more susceptible to chronic illnesses.

As we’ve discussed previously, erectile dysfunction can be caused by numerous different factors. However many of the physical causes, such as high blood pressure, high cholesterol, type-2 diabetes and obesity, are chronic illnesses which can often be related to lifestyle.

A very simplified interpretation of our data might be that men living in areas with higher wages might generally keep healthier lifestyles, and be less susceptible to the chronic conditions of which erectile dysfunction is often a secondary effect; and therefore less likely to seek treatment for ED.

However, it is not possible to make this assumption without access to more detailed data (such as: what other, if any, conditions did each patient seeking treatment for ED have; and the age and disposable income of each patient).

Smoking

In addition to measuring the number of sildenafil prescriptions issued against disposable household income, we also thought it might be interesting to look at several other key health indicators.

Among these were exercise habits, alcohol habits and obesity statistics for each UK region.

While there were no significant correlations between the above fields and the number of sildenafil prescriptions issued, we did notice a very slight parallel with smoking prevalence:

Sildenafil -prescriptions -vs -Smokers

The North East is the region with the highest prevalence of smokers, according to figures from the ONS (22.3%); and Greater London has the second to lowest prevalence (only 17.3% of Londoners smoke).

Smoking can induce or exacerbate erectile dysfunction; so once more, a very simplified interpretation of our data might be that a higher prevalence of smokers in a particular region leads to more men seeking treatment for ED, and fewer smokers means fewer men seeking treatment for ED.

However, once again, it is not possible to state that the comparative abundance of smokers in one region is the direct cause of more sildenafil prescriptions being issued. To make this assertion, we would again need to analyse more detailed and up-to-date data; particularly the number of men seeking treatment for ED who smoked or did not smoke in 2015-6 (the smoking data we have used was published in 2013).

The smoking figures we’ve presented also correspond to total prevalence across both sexes; to examine the link between smoking prevalence and sildenafil prescriptions more accurately, we would need to examine male-only smoking prevalence.

Check out the full results of our analysis below:

Sildenafil -by -postcode _Table (2)

Page last reviewed:  23/03/2018