Rich People Drive Up Antibiotic Use

From “Competition For Wealthy Elites Drives Up Antibiotic Prescription Rates,” by News Staff, Science 2.0, Feb. 25, 2015.

Competition between doctors’ offices, urgent care centers and retail medical clinics that cater to wealthy elites often leads to an increase in the number of antibiotic prescriptions written per person, finds a new analysis.

The number of physicians per capita and the number of clinics are significant drivers of antibiotic prescription rate, they found, with the highest per capita rates of antibiotic prescriptions found in the southeastern U.S. and along the West and East coasts. The team’s comparative analysis of data for the years 2000 and 2010 were collected from the U.S. Census Bureau and the IMS Health Xponent database, which tracks prescriptions dispensed at the ZIP code level. Notably high rates were found in Manhattan, southern Miami and Encino.

The data showed that the presence of retail medical clinics, like those found in chain drug and “super” stores, and of urgent care centers increases the prescribing rate, but the effect was different in wealthy versus poor areas.

In wealthy areas, the presence of clinics correlated to an increase in the prescribing rate of physicians. However, while the presence of retail or urgent care clinics in poorer areas increased access to health care, it did not generate competition among providers that resulted in higher prescribing behavior by physicians’ offices.

The study: Influence of provider and urgent care density across different socioeconomic strata on outpatient antibiotic prescribing in the USA. Klein EY, Makowsky M, Orlando M, Hatna E, Braykov NP, Laxminarayan R. J Antimicrob Chemother 2015 Jan 20 [Epub ahead of print]

We found large geographical variation in prescribing, driven in part by the number of physician offices per capita. For an increase of one standard deviation in the number of physician offices per capita there was a 25.9% increase in prescriptions per capita. However, the determinants of the prescription rate were dependent on socioeconomic conditions. In poorer areas, clinics substitute for traditional physician offices, reducing the impact of physician density. In wealthier areas, clinics increase the effect of physician density on the prescribing rate.

http://www.ncbi.nlm.nih.gov/pubmed/25604743

It also means that the people who are the most likely to benefit from antibiotics, due to higher rates of exposure to pathogens, are also the least likely to receive them.

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