Knowledge and use of antibiotics in six ethnic groups: the HELIUS study

Abstract

BackgroundThe increase of antimicrobial resistance, mainly due to increased antibiotic use, is worrying. Preliminary evidence suggests that antibiotic use differs across ethnic groups in the Netherlands, with higher use in people of non-Dutch origin. We aimed to determine whether appropriate knowledge and use of antibiotics differ by ethnicity and whether knowledge on antibiotics is associated with antibiotic use.MethodsWe performed a cross-sectional study analyzing baseline data (2011–2015) from a population-based cohort (HELIUS study), which were linked to data from a health insurance register. We included 21,617 HELIUS participants of South-Asian Surinamese, African-Surinamese, Turkish, Moroccan, Ghanaian, and Dutch origin. Fifteen thousand seven participants had available prescription data from the Achmea Health Data-base (AHD) in the year prior to their HELIUS study visit. Participants were asked five questions on antibiotic treatment during influenza-like illness, pneumonia, fever, sore throat and bronchitis, from which higher versus lower antibiotic knowledge level was determined. Number of antibiotic prescriptions in the year prior to the HELIUS study visit was used to determine antibiotic use.ResultsThe percentage of individuals with a higher level of antibiotic knowledge was lower among all ethnic minority groups (range 57 to 70%) compared to Dutch (80%). After correcting for baseline characteristics, including medical conditions, first-generation African Surinamese and Turkish migrants received a significantly lower number of antibiotic prescriptions compared to individuals of Dutch origin. Only second-generation Ghanaian participants received more prescriptions compared to Dutch participants (aIRR 2.09, 95%CI 1.06 to 4.12). Higher level of antibiotic knowledge was not significantly associated with the number of prescriptions (IRR 0.92, 95%CI 0.85 to 1.00).ConclusionsLevels of antibiotic knowledge varied between ethnic groups, but a lower level of antibiotic knowledge did not correspond with a higher number of antibiotic prescriptions.

Prevalence and Determinants of Antibiotic Consumption in the Elderly during 2006–2017

“…Despite the fact that we did not find any relationship between the BMI and antibiotic consumption, people who are overweight or obese are more likely to acquire an infection and thus need antibiotics compared with normal weight adults [59,60]. As found in another study [61], the likelihood of antibiotic consumption was greater in older people having a worse self-perceived health status, which may be because in a health system like the Spanish one, where access to care is universal, people with worse perceived health status visit their doctor regardless of their age. In the present study, the probability of antibiotic consumption was more than double in older people who had no polypharmacy.…”

Perspectives of Immigrants and Native Dutch on Antibiotic Use: A Qualitative Study

“…Both of these recent studies, as well as our own qualitative study, underline the worldwide trend towards lower expectations to receive antibiotics [ 32 ] and a decreasing trend in total antibiotic use in the European Union overall between 2011–2019 [ 23 ]. Moreover, they are consistent with the study of Schuts et al (2019) [ 18 ], which demonstrated no differences between six Dutch ethnic groups in the number of antibiotics used. Besides adapting to antibiotic guidelines in their host country, the reluctant antibiotic attitude of immigrants can also be derived from the implementation of antibiotic stewardship programs such as the National Action Plan (NAP), which was introduced in Turkey in 2014 [ 21 , 33 ].…”

“…This might explain why we found considerable similarities between immigrant and native Dutch participants regarding antibiotic attitude and use. In the literature, discussions often focus on differences between first- or second-generation immigrants [ 13 , 18 ], but it can be expected that there are also differences between first-generation immigrants depending on their length of stay in the host country. Nevertheless, similar findings were also reported by other recent studies.…”

“…Evidence also shows that immigrants have different perspectives and knowledge regarding antibiotic use. For instance, immigrants reason that other medications will be less effective for them because they are ‘used to’ antibiotics [ 17 ], they strongly believe in the curative power of antibiotics [ 14 ], and they have a lower level of antibiotic knowledge [ 18 ].…”

The Healthy Life in an Urban Setting (HELIUS) study in Amsterdam, The Netherlands: cohort update 2024 and key findings

“…For COVID-19, our results suggested that inequalities in hospitalization risk were also attributable to the higher rate of comorbidities (i.e., diabetes and hypertension) in specific ethnic minority groups. We also found that levels of knowledge regarding antibiotics use and prescriptions varied between ethnic groups (36). This is of concern, as antimicrobial resistance can impact the treatment and prevention of bacterial infections.…”