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A study by CUNY SPH doctoral student Eslam Abousamra and Distinguished Professor Luisa N. Borrell found major disparities in antibiotic use across age groups, sex, race/ethnicity, education levels, insurance status, health conditions, and geographic regions in the United States.
Inappropriate antibiotic use is a major contributor to the growing problem of antimicrobial resistance, a threat responsible for millions of deaths globally and thousands within the United States each year. Previous research has shown that antibiotics are often misunderstood and unnecessarily prescribed, but it was unclear whether disparities tied to sociodemographic and health-related factors persisted and, foremost, whether those associated with race/ethnicity and geographic region changed over time, especially following the disruptions caused by the COVID-19 pandemic.
For the study, published in Preventive Medicine, the authors analyzed data from the Medical Expenditure Panel Survey (2017–2022) for 118,110 U.S. adults aged 18 years or older. They examined whether each participant had at least one filled prescription for systemic antibiotics during a calendar year.
To identify patterns, the authors considered sociodemographic factors (age, sex, race and ethnicity, education, insurance status, and geographic region), health conditions, and healthcare utilization data. They applied descriptive statistics and Poisson regression models to estimate prevalence ratios, adjusting for all relevant covariates. These methods accounted for the complex survey design and sampling weights to ensure national representativeness of their findings.
They found that 14.3% of U.S. adults reported antibiotic use. After adjusting for various factors, adults aged 65 years or older were 27% more likely to use antibiotics than those aged 18-34. Women had a 45% higher likelihood of using antibiotics than men. Privately insured individuals showed a 67% greater probability of use than uninsured adults. Higher education levels were associated with increased antibiotic use. Hispanic, Black, and Asian adults used antibiotics less than White adults, even after adjustments. Regionally, antibiotic use was higher in the South and Midwest than in the Northeast. Chronic bronchitis showed the strongest association with higher antibiotic use.
“Notably, racial/ethnic and regional disparities in antibiotic use remained stable before, during, and after the COVID-19 pandemic,” says Distinguished Professor Borrell. “However, these disparities were attenuated during and after the pandemic, indicating the need for targeted strategies to address inequities and improve antibiotic stewardship.”
“Understanding these patterns is crucial to design interventions and ensure equitable, responsible antibiotic use across all demographic groups, which can help contain resistance, improve health outcomes, and inform public health policy,” says Abousamra.
