PMID- 32449917
OWN - NLM
STAT- MEDLINE
DCOM- 20210624
LR  - 20210624
IS  - 1460-2091 (Electronic)
IS  - 0305-7453 (Linking)
VI  - 75
IP  - 8
DP  - 2020 Aug 1
TI  - Antibiotic use and deprivation: an analysis of Welsh primary care antibiotic 
      prescribing data by socioeconomic status.
PG  - 2363-2371
LID - 10.1093/jac/dkaa168 [doi]
AB  - 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.
CI  - (c) The Author(s) 2020. Published by Oxford University Press on behalf of the 
      British Society for Antimicrobial Chemotherapy. All rights reserved. For 
      permissions, please email: journals.permissions@oup.com.
FAU - Adekanmbi, Victor
AU  - Adekanmbi V
AD  - Division of Population Medicine, School of Medicine, Cardiff University, Cardiff 
      CF14 4YS, UK.
FAU - Jones, Hywel
AU  - Jones H
AD  - Division of Population Medicine, School of Medicine, Cardiff University, Cardiff 
      CF14 4YS, UK.
FAU - Farewell, Daniel
AU  - Farewell D
AD  - Division of Population Medicine, School of Medicine, Cardiff University, Cardiff 
      CF14 4YS, UK.
FAU - Francis, Nick A
AU  - Francis NA
AD  - Division of Population Medicine, School of Medicine, Cardiff University, Cardiff 
      CF14 4YS, UK.
AD  - Primary Care, Population Sciences and Medical Education, University of 
      Southampton, Southampton SO17 1BJ, UK.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - J Antimicrob Chemother
JT  - The Journal of antimicrobial chemotherapy
JID - 7513617
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - *Anti-Bacterial Agents/therapeutic use
MH  - *Antimicrobial Stewardship
MH  - Cohort Studies
MH  - Humans
MH  - Practice Patterns, Physicians'
MH  - Primary Health Care
MH  - Social Class
EDAT- 2020/05/26 06:00
MHDA- 2021/06/25 06:00
CRDT- 2020/05/26 06:00
PHST- 2019/11/29 00:00 [received]
PHST- 2020/02/28 00:00 [revised]
PHST- 2020/03/31 00:00 [accepted]
PHST- 2020/05/26 06:00 [pubmed]
PHST- 2021/06/25 06:00 [medline]
PHST- 2020/05/26 06:00 [entrez]
AID - 5843864 [pii]
AID - 10.1093/jac/dkaa168 [doi]
PST - ppublish
SO  - J Antimicrob Chemother. 2020 Aug 1;75(8):2363-2371. doi: 10.1093/jac/dkaa168.