Gender inequality and antibiotic consumption: analysis of pharmaceutical sales data from 70 countries, 2000-22

Gender shapes health behaviours, access, and outcomes, thereby influencing antibiotic use. Intersecting socio-economic factors, such as education, labour force participation, and political representation, further mediate gender differences in the risk of antimicrobial resistance (AMR). However, evidence linking gender inequalities to antibiotic consumption remains limited.

This study is an observational, country-level analysis using IQVIA MIDAS® data on yearly antibiotic consumption (defined daily doses/DDDs) from 70 countries (2000-22). We used four gender equality indicators: proportion of females with secondary or higher education, female-to-male labour force participation (FMLFP) ratio, proportion of women in parliament, and share of female population. Using country and year fixed-effects regression models, the study estimated within-country associations between these indicators and overall antibiotic consumption, as well as by antibiotic class, controlling for income, education, healthcare access, and health spending, and demographics. Sensitivity was assessed through an alternative model specification, stratified analyses by income groups and by time periods.

Antibiotic consumption varied widely across countries with an average of 19.13 DDDs per day per 1000 population. Our main findings are that higher female education (P < 0.05) and FMLFP ratio (P < 0.01) were significantly associated with lower antibiotic consumption, while a higher share of females in the population was significantly associated with slightly higher consumption (P < 0.01). Women's parliamentary representation showed no significant association. These associations remained directionally consistent across alternative model specifications and income groups.

Gender inequalities influence antibiotic consumption patterns. The study underscores the need for a community-based approach in tackling AMR, specifically, investments in gender-responsive AMR strategies.