Socioeconomic Status and Determinants of Pediatric Antibiotic Use

Abstract

Introduction. Evidence suggests that early-life antibiotic use can alter gut microbiome, predisposing children to obesity. The obesity epidemic has a disproportionate effect on individuals from lower socioeconomic status (SES). Thus, this study aims to explore the link between SES and antibiotic use. Design. We performed a retrospective cohort study of all babies born at and receiving 2 or more outpatient visits at a large, suburban health system in Illinois (United States) between 2007 and 2017. We collected data on zip code as a proxy for SES and antibiotic use in the first year of life. We also obtained comorbid diagnosis codes, race/ethnicity, gender, and number of inpatient, outpatient, and emergency department visits. Results. A total of 7224 patients met our study criteria. Children from low-poverty areas received a lifetime average of 4.28 prescriptions, while those from high-poverty neighborhoods received an average of 3.31 prescriptions. This was statistically significant in our unadjusted analysis but not after adjusting for covariates. Children from high-poverty areas were significantly more likely to receive more antibiotics at 48 hours, 1 week, and 1 month of life in our unadjusted analysis, but not after adjusting for covariates. In our unadjusted and adjusted analyses, children from high-poverty areas were significantly more likely to have received antibiotics at 1 week of life. Conclusion. The relationship between SES and antibiotic use warrants further investigation to help elucidate possible causes of the disproportionate impact obesity has in low-income communities.

Interstate Practice Variation and Factors Associated with Antibiotic Use for Suspected Neonatal Sepsis in the United States

“…However, even in newborns with the lowest risk of sepsis, (e.g., cesarean delivery, without labor or membrane rupture before delivery, and no antepartum concern for intra-amniotic infection or non-reassuring fetal status), a large retrospective cohort study found that 80% of term and preterm infants were administered antibiotics at the time of birth hospitalization [24]. Surprisingly, we found higher rates of AU among Black newborns compared to other races in contrast to other pediatric studies [25,26]. This could probably be due to clinical severity, prescribers' bias, parental expectations and presumed higher risk of early onset sepsis in African-American population [8,9].…”

“…24 Surprisingly, we found higher rates of AU among Black newborns compared with other races in contrast to other pediatric studies. 25,26 This could probably be due to clinical severity, prescribers' bias, parental expectations, and presumed higher risk of early-onset sepsis in African American population. 8,9 Higher AU in deliveries with chorioamnionitis is not unexpected.…”

Factors of geographical variability of antimicrobial use in Japan

“…Population age and sex, the average income per household, the ratio of upper secondary graduates going to further education and the average age of physicians were obtained from Statistic Bureau, Ministry of Internal Affairs and Communications [22]. The physician's age was included in the variables because some studies showed physicians' experience is related with antibiotic prescriptions [13,17]. The number of clinics, the number of hospitals, the rate of hospitals with > 500 beds and the number of healthcare facilities with additional reimbursement for infection prevention 1 and 2 were obtained from regional bureaus of Health and Welfare (e.g., Kanto-Shinetsu) [24,25].…”

“…While geographical variabilities of AMU within a country were reported in some studies, the evidence regarding the factors affecting the geographical variation of AMU is relatively scarce [8, 9,10,11,12]. In general, physician-level factors (e.g., physician's experiences) and patient-level factors (e.g., patient age, sex and socioeconomic status) have been reported to impact physician's behavior of antimicrobial prescription [13,14,15,16,17,18]. The investigation of these factors to evaluate their potential impact on geographical variability using nationwide data may contribute to the identi cation of potential measures to reduce AMU and the promotion of appropriate AMU in the future.…”

Exiting the Anthropocene: Achieving personal and planetary health in the 21st century

“…In many ways, microbiome science has served to illuminate the unseen or otherwise ignored links between health at personal, public, and planetary scales—in tangible and measurable ways. For example, in addition to over‐prescription of antibiotics, 59 many other factors such as air pollution, 60 environmental toxins, 61 psychological stress, 62 , 63 ultra‐processed food 64 and dietary advanced glycation end‐products (AGEs), 65 emulsifiers, 66 phthalates 67 ), sleep disruption, 68 tobacco use, 69 sedentary behavior, 70 and excess alcohol consumption, 71 have been shown to impact the microbiome. Again.…”