Explaining socioeconomic inequalities in antibiotic prescribing for common infections in English primary care: a population-based study

OBJECTIVES

To quantify socioeconomic inequalities in antibiotic prescribing for common infections in primary care, and assess whether these inequalities arise from differences in consultation frequency, prescribing behaviour, or variation in vaccination uptake, smoking, and body mass index.

DESIGN

Population based cohort study.

SETTING

Primary care data from Clinical Practice Research Datalink, England.

PARTICIPANTS

17,195,399 children and adults estimated to have been registered with a general practice in 2019.

MAIN OUTCOME MEASURES

Antibiotic prescribing rates (prescriptions per person-year), consultation rates (consultations per person-year), and probability of receiving an antibiotic prescription following consultation.

RESULTS

Higher deprivation was associated with higher antibiotic prescribing rates for most respiratory tract indications. In children, prescribing rates were 44.8% (95% confidence interval [CI] 41.9% to 47.7%) higher for upper respiratory tract infections and 47.6% (95% CI 44.2% to 51.3%) higher for lower respiratory tract infections in the most versus least deprived twentile. In adults, prescribing rates for lower respiratory tract infections were 22.7% (95% CI 21.4% to 24.1%) higher in the most deprived twentile. Prescribing rates for other indications showed weak, U-shaped, or negative associations with deprivation. Prescribing inequalities were primarily driven by inequalities in consultation rates rather than probability of receiving antibiotics once consulted. Lower influenza vaccination uptake partly accounted for higher consultation rates for respiratory infections among more deprived children, while smoking prevalence contributed to inequalities among adults.

CONCLUSIONS

Socioeconomic inequalities in antibiotic prescribing vary by indication type and are largely explained by consultation frequency. Reducing inequalities may require interventions that decrease the need to consult, e.g. improving influenza vaccination coverage in children and reducing smoking among adults, rather than focussing solely on prescribing behaviour.

Summary boxes

What is already known on this topic

Overall antibiotic prescribing rates are higher in more deprived areas in the UK and internationally.

The relationship between deprivation and the probability of receiving antibiotics differs across common infections, many of which infrequently require antibiotics.

It remains unclear whether inequalities reflect differences in consultations, prescribing decisions, or underlying risk factors.

What this study adds

This study quantifies deprivation-related inequalities in antibiotic prescribing across 17 common indications and explores underlying mechanisms.

Socioeconomic inequalities in antibiotic prescribing varied by indication: higher deprivation was consistently associated with higher antibiotic prescribing rates (and wider variation in prescribing) for most respiratory tract indications, with rates 4% to 151% higher in the most deprived compared with the least deprived.

Inequalities in prescribing were largely explained by differences in consultation frequency, not by the likelihood of receiving antibiotics once a consultation occurred.

Lower vaccine uptake partly accounted for the higher consultation rates for respiratory indications in deprived children, while higher smoking prevalence contributed to inequalities among adults.