Health Equity and Antibiotic Prescribing in the United States: A Systematic Scoping Review

Abstract

We performed a scoping review of articles published from January 1, 2000 to January 4, 2022 to characterize inequities in antibiotic prescribing and use across U.S. healthcare settings to inform antibiotic stewardship interventions and research. We included 34 observational, 21 cross-sectional survey studies, four intervention studies, and two systematic reviews. Most studies, 55 (90%) of 61, described the outpatient setting, three articles from dentistry, two from long-term care, and one from acute care. Differences in antibiotic prescribing were found by patient’s race and ethnicity, sex, age, socioeconomic factors, geography, clinician’s age and specialty, and healthcare setting, with an emphasis on outpatient settings. Few studies assessed stewardship interventions. Clinicians, antibiotic stewardship experts, and health systems should be aware that prescribing behavior varies according to both clinician- and patient-level markers. Prescribing differences likely represent structural inequities, however no studies reported underlying drivers of inequities in antibiotic prescribing.

The urgent need for nurse practitioners to slow antibiotic resistance and advance health equity through appropriate antibiotic prescribing

“…Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health (CDC, 2022). Antibiotic prescribing health equity is ensuring that all patients, regardless of race, ethnicity, socioeconomic status, or availability of resources, have access to the highest quality of antibiotic therapy required to manage their health conditions (Kim et al, 2023). Recognizing the burgeoning role of NPs in antibiotic prescribing, it is time for NPs to mobilize and lead a movement to slow ABR and advance health equity through appropriate antibiotic prescribing across the continuum of care.…”

“…Many risks for ABR infections are linked to social determinants of health, where a person lives, environmental exposures, how often one engages with the health care system, quality of care received, and socioeconomic and other factors that contribute to disparities in health outcomes (CDC, 2022;Kim et al, 2023). For example, community-associated extended spectrum beta-lactamase-producing Enterobacterales infections have higher incidence rates in certain geographic areas with lower median incomes, lower high school education rates, higher percentages of persons without health insurance, and limited English proficiency (CDC, 2022).…”