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Antibiotic use and deprivation: an analysis of Welsh primary care antibiotic prescribing data by socioeconomic status

Antibiotic use and deprivation: an analysis of Welsh primary care antibiotic prescribing data by socioeconomic status
Antibiotic use and deprivation: an analysis of Welsh primary care antibiotic prescribing data by socioeconomic status

OBJECTIVES: To examine the association between socioeconomic status (SES) and antibiotic prescribing, controlling for the presence of common chronic conditions and other potential confounders and variation amongst GP practices and clusters.

METHODS: This was an electronic cohort study using linked GP and Welsh Index of Multiple Deprivation (WIMD) data. The setting was GP practices contributing to the Secure Anonymised Information Linkage (SAIL) Databank 2013-17. The study involved 2.9 million patients nested within 339 GP practices, nested within 67 GP clusters.

RESULTS: Approximately 9 million oral antibiotics were prescribed between 2013 and 2017. Antibiotic prescribing rates were associated with WIMD quintile, with more deprived populations receiving more antibiotics. This association persisted after controlling for patient demographics, smoking, chronic conditions and clustering by GP practice and cluster, with those in the most deprived quintile receiving 18% more antibiotic prescriptions than those in the least deprived quintile (incidence rate ratio = 1.18; 95% CI = 1.181-1.187). We found substantial unexplained variation in antibiotic prescribing rates between GP practices [intra-cluster correlation (ICC) = 47.31%] and GP clusters (ICC = 12.88%) in the null model, which reduced to ICCs of 3.50% and 0.85% for GP practices and GP clusters, respectively, in the final adjusted model.

CONCLUSIONS: Antibiotic prescribing in primary care is increased in areas of greater SES deprivation and this is not explained by differences in the presence of common chronic conditions or smoking status. Substantial unexplained variation in prescribing supports the need for ongoing antimicrobial stewardship initiatives.

0305-7453
2363-2371
Adekanmbi, Victor
46d212c3-bfe7-468e-8f11-0574bbbb90bd
Jones, Hywel
08149e0a-2674-423f-ba25-d16303fbe3cd
Farewell, Daniel
bb0b8839-4fd9-418d-976f-f732002b2f8d
Francis, Nick A.
9b610883-605c-4fee-871d-defaa86ccf8e
Adekanmbi, Victor
46d212c3-bfe7-468e-8f11-0574bbbb90bd
Jones, Hywel
08149e0a-2674-423f-ba25-d16303fbe3cd
Farewell, Daniel
bb0b8839-4fd9-418d-976f-f732002b2f8d
Francis, Nick A.
9b610883-605c-4fee-871d-defaa86ccf8e

Adekanmbi, Victor, Jones, Hywel, Farewell, Daniel and Francis, Nick A. (2020) Antibiotic use and deprivation: an analysis of Welsh primary care antibiotic prescribing data by socioeconomic status. Journal of Antimicrobial Chemotherapy, 75 (8), 2363-2371. (doi:10.1093/jac/dkaa168).

Record type: Article

Abstract

OBJECTIVES: To examine the association between socioeconomic status (SES) and antibiotic prescribing, controlling for the presence of common chronic conditions and other potential confounders and variation amongst GP practices and clusters.

METHODS: This was an electronic cohort study using linked GP and Welsh Index of Multiple Deprivation (WIMD) data. The setting was GP practices contributing to the Secure Anonymised Information Linkage (SAIL) Databank 2013-17. The study involved 2.9 million patients nested within 339 GP practices, nested within 67 GP clusters.

RESULTS: Approximately 9 million oral antibiotics were prescribed between 2013 and 2017. Antibiotic prescribing rates were associated with WIMD quintile, with more deprived populations receiving more antibiotics. This association persisted after controlling for patient demographics, smoking, chronic conditions and clustering by GP practice and cluster, with those in the most deprived quintile receiving 18% more antibiotic prescriptions than those in the least deprived quintile (incidence rate ratio = 1.18; 95% CI = 1.181-1.187). We found substantial unexplained variation in antibiotic prescribing rates between GP practices [intra-cluster correlation (ICC) = 47.31%] and GP clusters (ICC = 12.88%) in the null model, which reduced to ICCs of 3.50% and 0.85% for GP practices and GP clusters, respectively, in the final adjusted model.

CONCLUSIONS: Antibiotic prescribing in primary care is increased in areas of greater SES deprivation and this is not explained by differences in the presence of common chronic conditions or smoking status. Substantial unexplained variation in prescribing supports the need for ongoing antimicrobial stewardship initiatives.

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More information

Accepted/In Press date: 31 March 2020
e-pub ahead of print date: 25 May 2020
Published date: August 2020

Identifiers

Local EPrints ID: 441419
URI: http://eprints.soton.ac.uk/id/eprint/441419
ISSN: 0305-7453
PURE UUID: ec3fe175-bf7e-4637-822d-7adccbf494d9
ORCID for Nick A. Francis: ORCID iD orcid.org/0000-0001-8939-7312

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Date deposited: 11 Jun 2020 16:41
Last modified: 10 Jan 2022 06:26

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Contributors

Author: Victor Adekanmbi
Author: Hywel Jones
Author: Daniel Farewell
Author: Nick A. Francis ORCID iD

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