Increase in anticholinergic burden from 1990 to 2015: Age-period-cohort analysis in UK biobank

Br J Clin Pharmacol. 2022 Mar;88(3):983-993. doi: 10.1111/bcp.15045. Epub 2021 Sep 19.


Background: The 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.

Methods: We performed an age-period-cohort (APC) analysis to study trends in an aggregate measure of anticholinergic burden between the years 1990 and 2015, utilising data from >220 000 UK Biobank participants with linked prescription data from primary care.

Results: Anticholinergic burden in the sample increased up to 9-fold over 25 years and was observed for both period and age effects across most classes of drugs. The greatest increase was seen in the prescribing of antidepressants. Female sex, lower education and greater deprivation were associated with greater anticholinergic burden.

Conclusions: The increase in anticholinergic prescribing is mostly due to an increase in polypharmacy and is attributable to both ageing of participants and period-related changes in prescribing practices. 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.

Keywords: anticholinergic drugs; drug prescribing; general practice; polypharmacy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biological Specimen Banks*
  • Cholinergic Antagonists* / adverse effects
  • Cohort Studies
  • Female
  • Humans
  • Polypharmacy
  • United Kingdom / epidemiology


  • Cholinergic Antagonists