Assessing Disparities in Inappropriate Outpatient Antibiotic Prescriptions in Tennessee

Area of Science:

• Health Services Research
• Public Health
• Infectious Disease Epidemiology

Background:

• Over 200 million outpatient antibiotic prescriptions were issued in the U.S. in 2022, with 30% being unnecessary.
• Demographic factors influence antibiotic prescribing, but social determinants of health (SDOH) impact on prescribing inequities are understudied.
• This study investigates SDOH-related disparities in outpatient antibiotic prescribing in Tennessee.

Purpose of the Study:

• To explore health inequities in antibiotic prescribing patterns in Tennessee.
• To identify factors contributing to unnecessary antibiotic prescriptions.
• To assess the role of the Social Vulnerability Index (SVI) in antibiotic prescribing disparities.

Main Methods:

• Cross-sectional study using IQVIA LRx and Dx databases (2022) linked to diagnoses.
• Antibiotic prescriptions categorized into three tiers based on appropriateness.
• Multivariable logistic regression analyzed age, gender, insurance, and SVI impact on prescribing.

Main Results:

• 59.3% of 2,874,505 analyzed prescriptions were inappropriate (Tier 3).
• Female patients and children received fewer inappropriate antibiotics.
• Lower SVI areas and private insurance were associated with lower odds of inappropriate prescriptions, while Medicaid/Medicare beneficiaries had higher odds.

Conclusions:

• Significant health disparities exist in Tennessee's outpatient antibiotic prescribing.
• Males, older adults, and individuals in socioeconomically vulnerable areas are more prone to receiving inappropriate prescriptions.
• Targeted public health interventions are crucial to reduce unnecessary antibiotic use and address health inequities.