Parents’ socioeconomic factors related to high antibiotic prescribing in primary health care among children aged 0–6 years in the Capital Region of Denmark

Abstract

ObjectiveTo investigate the distribution of antibiotic prescriptions in primary health care among children aged 0–6 years and its association with socioeconomic factors.DesignA cross-sectional study describing antibiotic prescriptions and socioeconomic factors, using different population-based registers from Statistics Denmark.SettingAntibiotic prescriptions in 2012 from primary health care in the Capital Region of Denmark.SubjectsThe population of children aged 0–6 years (n = 139,398) in the Capital Region of Denmark.Main outcome measuresHigh use of antibiotics identified by number of antibiotic prescriptions (≥ 3 prescriptions per year) and defined daily doses (DDD). A multinomial logistic regression analysis estimating the association between high antibiotic use and parents’ education, employment status, income, child’s sex, and ethnic background.ResultsTen percent of children accounted for 25% of the total use DDD. There was a clear tendency that the risk for high antibiotic use increased as parental educational level decreased. The risk for high use was the highest among children of mothers and fathers with basic schooling ≤10 years (OR 1.60, 95% CI 1.29–1.98, and OR 1.60, 95% CI 1.34–1.91, respectively). Low income and unemployment were not associated with high antibiotic use.ConclusionSocioeconomic factors can only partially explain differences in antibiotic use. Further research is needed to clarify the unequal distribution of antibiotic prescribing and the association between high antibiotic use and low educational level. This would provide valuable information in the planning of strategies to promote rational use of antibiotics among children.Key Points The Capital Region of Denmark has the highest rate of antibiotic prescribing in Denmark.Preschool children are among the age groups with the highest use.Ten percent of the children accounted for 25% of the total antibiotic use.Low parental educational level was associated with increased antibiotic use.Parents’ income or employment status was not found to be associated with high antibiotic use.

Antibiotic Consumption, Resistance Data, and Prevention Strategies

“…Families, especially mothers, attach great importance to past experience. Parents who have previously observed their child recover from a fever by using antibiotics tend to want to use antibiotics for every similar episode later and can be insistent about this toward physicians [56] . Similarly, parents who claim their febrile child is not improving sufficiently and demand re-evaluation can be more insistent about the prescription of antibiotics by physicians [57] .…”

“…It was reported that if maternal pressure to get antibiotics could be reduced, the amount of antibiotics prescribed to children could be reduced by nearly half [56] . In a study in which families were asked where they got information about antibiotics, the most common source was physicians, followed by television and relatives [53] .…”

Transforming Life: A Broad View of the Developmental Origins of Health and Disease Concept from an Ecological Justice Perspective

“…Antibiotic exposure is often higher in disadvantaged populations [260,261,262]. The microbes carried by mammals are also a product of the ecosystems in which they reside [263,264,265,266]; given that the Earth is home to upward of 1 trillion microbial species [267], human contact with many of these microbes in natural environments (the ecosystem in which we once spent the majority of our time) may have evolutionary-rooted, health-protective properties.…”

“…Moreover, in the relationship between physician empathy, humility and good medical outcomes, perception is likely a reality [345,346]. Given that inappropriate antibiotic prescriptions remain alarmingly high [347], it is worth noting that in the visualized neighborhood, one where primary care demands are typically strong, consultations shorter and provider stress is higher [348], a physician visit in our neighborhood is more likely to conclude with an antibiotic prescription [260,261,262]. Clearly, the “ecology“ of the patient visit and its direct and indirect effects on the microbiome requires further study.…”

Are changes needed in the content of general practice?

“…More evidence on the role of social determinants in patient well-being is being uncovered, for example, that parents’ socioeconomic factors are related to higher antibiotic prescribing for children. [6] However, despite the fact that western countries are spending more money on their health system, inequality still exists and is even increasing. People on low incomes and immigrants are accepting different health care service than those who have higher incomes and less social problems.…”