Appropriateness and determinants of outpatient antibiotic use among migrants in British Columbia, Canada: a...

Migrants represent a diverse population whose unique experiences and healthcare barriers may influence antibiotic prescribing. This study examined the appropriateness of outpatient antibiotic prescriptions and determinants of inappropriate prescriptions among migrants in British Columbia, Canada.

We conducted a population-based retrospective cohort study using health administrative databases. Antibiotic prescriptions were classified as appropriate, potentially appropriate, never appropriate, or unknown for migrants and non-migrants based on physician billing diagnostic codes. We used multivariable ordinal regression models to identify the determinants of antibiotic prescription appropriateness in 2022.

From 2000 to 2022, the overall outpatient antibiotic prescribing rates declined by 45.3% in migrants and by 42.7% in non-migrants. Migrants had a higher proportion of never-appropriate prescriptions and a lower proportion of appropriate prescriptions than non-migrants. After adjustment for patient and prescriber factors, migrants were associated with less appropriate prescribing than non-migrants (odds ratio [OR] 1.12, 95% CI 1.11-1.13) in 2022. More than half of migrant prescription episodes were in the 35-64 years age group and were more likely to receive care from higher-volume physicians who were, on average, slightly older. Inappropriate prescribing was more likely among younger patients (0-11 versus 65+ years: OR 1.10, 95% CI 1.08-1.12), lower-income groups (lowest versus highest quintile: OR 1.04, 95% CI 1.03-1.05), and prescriptions from surgical (versus GP's: OR 1.38, 95% CI 1.31-1.45) and urological specialists (versus GP: OR 3.06, 95% CI 2.67-3.51).

While antibiotic prescribing appropriateness in BC has improved, inappropriate use remains common, particularly among the migrant population. Improving prescribing quality and equity requires strengthening stewardship in outpatient settings.