Income level and antibiotic misuse: a systematic review and dose–response meta-analysis

Abstract

Objectives To quantify the association between income and antibiotic misuse including unprescribed use, storage of antibiotics and non-adherence. Methods We identified pertinent studies through database search, and manual examination of reference lists of selected articles and review reports. We performed a dose–response meta-analysis of income, both continuous and categorical, in relation to antibiotic misuse. Summary odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated under a random-effects random effects model. Results Fifty-seven studies from 22 countries of different economic class were included. Overall, the data are in agreement with a flat linear association between income standardized to socio-economic indicators and antibiotic misuse (OR per 1 unit increment = 1.00, p-value = 0.954, p-value non-linearity = 0.429). Data were compatible with no association between medium and high income with general antibiotic misuse (OR 1.04; 95% CI 0.89, 1.20 and OR 1.03; 95% CI 0.82, 1.29). Medium income was associated with 19% higher odds of antibiotic storage (OR 1.19; 95% CI 1.07, 1.32) and 18% higher odds of any aspect of antibiotic misuse in African studies (OR 1.18; 95% CI 1.00, 1.39). High income was associated with 51% lower odds of non-adherence to antibiotic treatment (OR 0.49; 95% CI 0.34, 0.60). High income was also associated with 11% higher odds of any antibiotic misuse in upper-middle wealth countries (OR 1.11; 95% CI 1.00, 1.22). Conclusions The association between income and antibiotic misuse varies by type of misuse and country wellness. Understanding the socioeconomic properties of antibiotic misuse should prove useful in developing related intervention programs and health policies.

Assessment of Rational Use of Antibiotics: A Nationwide Cross-Sectional Study among People of Nepal

“…Our study showed that the knowledge and practice of antibiotics use and AMR is significantly dependent on the education level of the respondents which align with the findings of a study done in Lithuania where people with an education level of a college degree and above had better knowledge, more appropriate behaviours, and better practices [46]. Similarly, the level of income was significantly and synonymously associated with the behaviour and practice of antibiotic use in our study which contrasts with a study performed recently but a similar finding was seen in one of the studies in Saudi Arabia [47,48]. The same study demonstrated a significant association between the nature of work and behaviour and practice on antibiotic use like our study where health professionals were better informed about the correct use of antibiotics.…”

Influence of age, socioeconomic status, and location on the infant gut resistome across populations

“… 43 The socio-demographic status of a country has been shown to be associated with HAQ 39 and a small increase in the misuse of antibiotics is observed in middle- and high-income countries. 44 These differences in rates of antibiotic consumption in various countries over time also explain the differing results of our study from other large-scale resistome studies by Hendriksen et al 37 and Munk et al 45 …”

PCL/Gelatin/Graphene Oxide Electrospun Nanofibers: Effect of Surface Functionalization on In Vitro and Antibacterial Response

“…According to the Centre for Disease Control, CDC (2019), antibiotic-resistant bacteria have caused at least 2,868,700 infections with 35,900 reported deaths [ 1 ]. The overuse and misuse of antibiotics contribute to the development of these superbugs [ 2 , 3 , 4 , 5 ]. Thus, infectious diseases are harder to treat as antibiotics become less effective, causing damage to the immune system and leading to treatment failure [ 6 , 7 ].…”