Association of factors linked to health inequalities and the risk of antibiotic-resistant infection in high-income countries: a systematic scoping review

Introduction

Antibiotic-resistant infections disproportionately affect vulnerable populations, yet research on health inequalities in this context remains limited. This scoping review explores the relationship between health inequalities and the risk of antibiotic-resistant infections in high-income countries.

Method

A comprehensive search was performed on Ovid Embase, Ovid Medline (R) All, and Google Scholar, including studies published between January 2010 and February 2024 from high-income countries. The search focused on key pathogens identified by the 2018-24 UK AMR National Action Plan. Health inequalities were defined by factors such as socioeconomic status (income, employment), protected characteristics (age, gender, ethnicity), and vulnerable groups (e.g., migrants, homeless individuals, and sex workers). Studies on sexually transmitted, foodborne, viral, or fungal infections, and those from low-or middle-income countries were excluded.

Results

Of 203 papers reviewed, 18 were included. Most studies were from the U.S (12), followed by the UK (2), New Zealand (2), Australia (1), and a European study. The most frequently studied pathogen was Staphylococcus aureus, with ethnicity, socioeconomic deprivation and age being the primary factors explored. A few studies also considered migration status.

In the U.S., Black patients exhibited higher Methicillin-resistant Staphylococcus aureus (MRSA) infection rates compared to White patients, with rates 2-3 times higher despite an overall decline in MRSA. Indigenous Australians similarly had higher MRSA rates.

Socioeconomic factors, such as deprivation and age, were significant risk factors; however, when accounting for these factors, racial disparities in MRSA were significantly reduced.

For Streptococcus pneumoniae infections, Hispanic patients showed higher penicillin resistance than non-Hispanic White patients. Escherichia coli resistance was more prevalent among lower-income individuals or those in high-deprivation areas, with ethnic minorities in New Zealand also disproportionately affected. Additionally, Helicobacter pylori infections were most common in Māori individuals in New Zealand, and income inequality was strongly linked to antibiotic resistance in Enterococcus, Klebsiella, and Pseudomonas in Europe.

Conclusion

This review highlights the potential impact of factors associated with health inequalities on the risk of antibiotic-resistant infections, with higher rates of resistant infection seemingly associated with ethnic minorities, especially Black and Indigenous populations, as well as with income inequalities.