Investigating the effect of climate and air pollution on prescription uptake in the England.

BACKGROUND: Climate change is increasingly recognised as a threat to population health and healthcare systems, yet the effects of environmental variability on pharmaceutical prescribing remain poorly characterised in the UK. Using a wide array of open-source datasets, we examine the effect of environmental, geographic and socioeconomic factors on prescribing habits in England. METHODS: We linked monthly, practice-level prescribing data for England (August 2010 - August 2025) to meteorological, air-quality, flooding and demographic datasets using spatial nearest-neighbour matching. Prescribing volumes for cardiovascular, respiratory and antibiotic medications were analysed using log-transformed outcomes in mixed-effects models with practice-level random effects, adjusting for region, seasonality, deprivation and temporal trends, using both continuous environmental measures and extreme-condition indicators. A complementary Bayesian hierarchical model jointly estimated the conditional effects of multiple correlated environmental exposures, with partial pooling across practices and support for distributed lag effects. RESULTS: In mixed-effects analyses, temperature showed the most consistent associations with prescribing, with higher temperatures linked to increased respiratory and cardiovascular prescriptions and reduced antibiotic use, while rainfall, flooding and most pollutants had small or negligible effects. Environmental predictors exhibited strong correlations, motivating multivariate modelling. Bayesian multivariate models confirmed temperature as the dominant environmental driver after adjustment for correlated exposures, with substantially larger variation attributable to regional and socioeconomic factors than to environmental conditions. CONCLUSIONS: Temperature is the most consistent environmental determinant of GP prescribing in England, with higher temperatures associated with increased cardiovascular and respiratory prescribing and reduced antibiotic use. Rainfall, flooding and most air pollutants show little evidence of meaningful effects once seasonal and meteorological structure is accounted for. Environmental associations are modest in magnitude relative to persistent socioeconomic and regional drivers of prescribing, indicating that climate-related influences operate within broader structural determinants of healthcare utilisation. These results suggest that, at monthly timescales, prescribing demand is relatively stable to environmental variability, supporting a focus on long-term adaptation and surveillance rather than short-term demand shocks in climate-resilient healthcare planning.