Influence of factors commonly known to be associated with health inequalities on antibiotic use in high-income countries: a systematic scoping review

Abstract

Introduction Inappropriate antibiotic use contributes to antimicrobial resistance. High-income countries have high rates of antibiotic use, with a prevalence of health inequalities amongst populations. Objectives To understand the influence of factors commonly known to be associated with health inequalities on antibiotic use in high-income countries. Methods Factors commonly known to be associated with health inequalities were defined as protected characteristics under UK’s Equality Act (age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race/ethnicity, religion or belief, sex, sexual orientation), socioeconomic characteristics (income, insurance, employment status, deprivation, education), geography (urban versus rural, region) and vulnerable groups. The study followed PRISMA-ScR and, PRISMA-E statements. Results Fifty-eight of 402 identified studies met inclusion criteria. Fifty of those papers (86%) included one or more protected characteristics, 37 (64%) socioeconomic characteristics, 21 (36%) geography and 6 (10%) vulnerable groups. Adults in older age groups, especially those in residential care, had the highest antibiotic use. The influence of race or ethnicity and antibiotic use was particular to country context. Areas of high deprivation had higher antibiotic use compared with areas of no or low deprivation, and geographical variation existed within countries. When faced with health system barriers, migrants relied on alternative routes of antibiotic supply other than prescription. Recommendations for future research To investigate how factors and wider social determinants of health interplay and impact antibiotic use, using frameworks/approaches to reduce health inequalities such as England’s Core20PLUS approach. Antimicrobial stewardship initiatives should equip healthcare professionals to review patients at the highest risk of antibiotic use.

What Does Disability Justice Require of Antimicrobial Stewardship?

“…1 In accordance with the DJ principle of intersectionality, we recommend incorporating demographic data related to disability status as well as other social identity factors, such as race and class, that shape how people's disabilities are interpreted and what explicit or implicit biases they may face in health care systems. 27,28,29,30 Given well-documented inequities in myriad health care settings where antibiotics are prescribed, we can expect these inequities to manifest in antibiotic prescribing practices. 31 Since inequitable care may show up as both under-and overprescribing, data tracking and analysis processes must incorporate data on the health care side (prescription and prescriber details, diagnostic workup, and treatment outcomes), as well as on the patient side (disability status and other sociodemographic details).…”