Antibiotic consumption in relation to socio-demographic factors, co-morbidity, and accessibility of primary health care.

BACKGROUND: Differences in antibiotic consumption between individuals are not only due to differences in primary infection morbidity, other non-medical factors are important. Our objective was to investigate how socio-demographic factors, co-morbidity, and access to primary care affect antibiotic prescribing.

METHODS: The study population included all 2 078 481 persons in Sweden who received at least one antibiotic prescription during 2010, and an unmatched control population of 788 580 individuals. We used record linkage to obtain data on co-morbidity, various socio-demographic variables, and waiting times for doctor appointments in primary care. We used logistic regression to estimate odds ratios (ORs) for antibiotic prescription.

RESULTS: The results showed that over 20% of the population were prescribed antibiotics during 2010. Children aged 0-5 years, persons ≥ 75 years of age, those living in urban areas, and women compared with men, received many prescriptions. Co-morbidity was a strong factor that determined the number of antibiotic prescriptions: those with Charlson's index ≥ 3 had an OR of 3.03 (95% CI: 3.00-3.07) to obtain antibiotics in the adjusted analysis, compared with individuals without co-morbidity (Charlson's index 0). Short waiting times for a doctor's visit in primary care were associated with a higher number of antibiotic prescriptions. Individuals born in Sweden were prescribed more antibiotics compared with those born in another country. Specifically, persons born in any of the 27 EU countries (excluding Scandinavia) had an OR of antibiotic prescription of 0.78 (95% CI: 0.77-0.78) compared with native-born individuals.

CONCLUSIONS: We conclude that non-medical factors strongly influence antibiotic prescriptions.