The Association of Oral Antibacterial Prescribing with Socioeconomic Deprivation in Primary Care in England: A Cross-Sectional Analysis

Background: Substantial variation in antibiotic prescribing rates between general practices persists; however, it remains unexplained at a national level. Objectives: To investigate a possible association between antibiotic prescribing and area-level socioeconomic deprivation. Methods: Antibiotic prescribing data were obtained from NHS Business Service Authority for the year 2022-2023. These data were linked to data on practice list size, age, and sex obtained from NHS Digital, and Index of Multiple Deprivation (IMD) 2019 scores. A multivariable Poisson regression was conducted to control for potential confounders, including practice list size, proportion of older age patients (>55 years), and proportion of females. Results: Approximately 5.2 million dispensed prescription items were analyzed. Antibiotic prescribing rate was associated with IMD quintile, with the most deprived quintile receiving 20% more antibacterial prescriptions than the least deprived. [IRR 1.20; (95% CI 1.08-1.34)]. Proportion of older age patients was the strongest predictor of prescribing [IRR 1.63; (95% CI 1.52- 1.74)], followed by proportion of females [IRR 1.09; (95% CI 0.99-1.21)]. GP practice list size was inversely related to prescribing [IRR 0.89; (95% CI 0.83-0.95)]. Conclusions: Primary care practices in socioeconomically deprived areas are associated with increased antibiotic prescribing, and this is not entirely explained by area-level characteristics nor by practice population structure. Considerable variation in prescribing remains unexplained, supporting the need for continuous antimicrobial campaigns.