Correlates of antibiotic use in U.S. adults: An analysis of medical expenditure panel survey data, 2017-2022.

Abstract

To identify sociodemographic and health-related correlates of antibiotic use in U.S. adults and determine whether racial/ethnic and regional disparities persisted throughout and after the COVID-19 pandemic. Using data from the Medical Expenditure Panel Survey (2017-2022) for 118,110 U.S. adults aged 18 years or older, Poisson regression was used to quantify the associations of interest via prevalence ratios (PR) and 95 % confidence intervals (CI). Effect modifications of race/ethnicity and region with pandemic periods were evaluated. The prevalence of antibiotic use was 14.3 %. In adjusted analyses, adults aged 65 or older (PR = 1.27, 95 %CI:1.20, 1.35), women (PR = 1.45, 95 %CI:1.40, 1.51), and privately insured individuals (PR = 1.67, 95 %CI:1.50,1.87) had higher antibiotic use than their counteraprts who were aged 18-34 years, men, and uninsured. Higher education was associated with a higher probability of antibiotic use. Hispanic (PR = 0.65, 95 %CI:0.60, 0.71), Black (PR = 0.61, 95 %CI: 0.57, 0.65), and Asian adults (PR = 0.54, 95 %CI:0.47, 0.62) use less antibiotics than White adults. Antibiotic used was greater in the South (PR = 1.18, 95 %CI:1.09, 1.28) and Midwest (PR = 1.12, 95 %CI:1.03, 1.22) than the Northeast. Chronic bronchitis showed the strongest association (PR = 1.34, 95 %CI:1.23, 1.46). No interactions of race/ethnicity and region with pandemic period were observed (p-values>0.12). Given the observed antibiotic use disparities, stewardship efforts require strategies targeting specific groups to address inequities.