Date of Conferral

2022

Degree

Ph.D.

School

Public Health

Advisor

Adebowale Awosika-Olumo

Abstract

Resistance to antibiotics among bacteria develops largely due to frequent use of antibiotics in human and animal medicine. Little is known about how patients’ socioeconomic factors, in conjunction with chronic health conditions, impact antibiotic prescribing rates in the United States. The research questions aimed to explore the relationship between poverty and antibiotic prescribing rates while also adjusting for confounders such as population aged ≥ 65, physician density, prevalence of obesity, diabetes, and chronic obstructive pulmonary disease (COPD). The relationships were evaluated using a quantitative, ecological study design using the ecosocial theory and mediation analysis of 2020 survey results provided by the Centers for Disease Control and Prevention (Behavioral Risk Factor Surveillance System, Antibiotic Resistance & Patient Safety Portal) and the Association of American Medical Colleges. Results showed a strong, linear relationship between prevalence of poverty and antibiotic prescribing rates. For every percent increase in prevalence of poverty in each state, the antibiotic prescribing rate increased by 17.4 courses (95% Confidence Intervals of 9.2, 24.9) of outpatient antibiotics per 1,000 population by indirect effects of poverty through mediators (COPD, obesity, and diabetes). Findings may impact positive social change by stimulating further studies leading to efforts directed at the quality improvement in measuring and tracking antibiotic use in clinical settings. Moreover, the results could encourage public health professionals to design and implement effective antibiotic stewardship programs by addressing clinical and social services needed to reduce prescribing rates.

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