Culture and Antimicrobial Consumption: Sector- and Class-Specific Differences in Country-Level Associations Across...

Area of Science:

• Global Health
• Sociology
• Pharmacology

Background:

• Antimicrobial consumption (AMC) varies significantly across European nations.
• Previous studies linked AMC variations to cultural values but did not differentiate between healthcare sectors or drug classes.
• This research addresses these gaps by examining sector- and class-specific associations.

Purpose of the Study:

• To investigate whether the association between cultural values and AMC differs between community and hospital settings.
• To determine if these associations vary across different antimicrobial classes.
• To identify specific cultural dimensions influencing AMC in distinct healthcare contexts.

Main Methods:

• Utilized country-level AMC data from the European Centre for Disease Prevention and Control for EU/EEA countries.
• Correlated Hofstede's cultural dimensions with AMC using Spearman's rank correlation, analyzing sector-specific (community, hospital) and Anatomical Therapeutic Chemical (ATC) group data.
• Employed bootstrap confidence intervals and permutation tests for uncertainty assessment, with sensitivity analyses including leave-one-country-out checks.

Main Results:

• Cultural values, particularly Power Distance Index (PDI) and Uncertainty Avoidance Index (UAI), showed stronger associations with community antibiotic use compared to hospital use.
• PDI and UAI correlations were significantly higher for community antibacterials (J01) than for hospital J01 and other community medicine groups.
• These findings remained robust across sensitivity analyses, confirming the distinct role of culture in community AMC.

Conclusions:

• National cultural context, especially PDI and UAI, is more closely linked to community antibiotic use than to hospital use or other community medicines.
• Cultural drivers of AMC are context-specific, highlighting the need for community-tailored antimicrobial stewardship strategies.
• Strategies should address cultural norms related to hierarchy and uncertainty to effectively manage community AMC.