Why are more highly educated people with dementia less likely to be prescribed antipsychotics?

Socio-economic disparities in utilization of health services are an important public health concern. Wastesson et al. (1) linked national data from the Swedish Prescribed Drug Register, Swedish Patient Register and Swedish Education Register to investigate whether education level was associated with antipsychotic use. Lower education (defined as <9 years) was associated with higher adjusted odds of antipsychotic use in the overall population (adjusted odds ratio [AOR] 1.56, 95% confidence interval [CI] 1.48–1.64) compared to higher education (defined as >12 years). When the sample was limited to people with dementia a similar association was also observed (AOR 1.43; 95% CI 1.28–1.59). The finding that more highly educated people with dementia had lower odds of antipsychotic use is intriguing. Sweden is a country with universal public health insurance. It is also renowned for its very low level of socio-economic inequalities and above average rates of secondary and tertiary education.