Division of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Disease, University of Texas Health Science Center, Houston, TX, United States.
Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States.
Front Public Health. 2022 Mar 10;10:832266. doi: 10.3389/fpubh.2022.832266. eCollection 2022.
The U.S.-Mexico Border is an area of opportunity for improved health care access; however, gaps remain as to how and where U.S. border residents, particularly those who are underinsured, obtain care. Antibiotics are one of the most common reported drivers of cross-border healthcare access and a medication of particular concern since indiscriminate or inappropriate use is associated with antimicrobial resistance. In addition, many studies assessing preferences for Mexican pharmaceuticals and healthcare in U.S. border residents were done prior to 2010 when many prescription medications, including antibiotics, were available over the counter in Mexico.
Data used in this study were collected during the baseline examination of an ongoing longitudinal cohort study in Starr Country, Texas, one of 14 counties on the Texas-Mexico border. Participants self-reported the name, date of use, and the source country of each antibiotic used in the past 12 months. Logistic regression was used to determine social, cultural, and clinical features associated with cross-border procurement of antibiotics.
Over 10% of the study cohort reported using antibiotics in the past 30 days with over 60% of all rounds used in the past 12 months sourced from Mexico. A lack of health insurance and generation score, a measure of acculturation, were the strongest predictors of cross-border procurement of antibiotics.
Factors previously associated with cross-border acquisition of antibiotics are still present despite changes in 2010 to prescription drug regulations in Mexico. These results may be used to inform future public health initiatives to provide culturally sensitive education about responsible antibiotic stewardship and to address barriers to U.S. healthcare and pharmaceutical access in medically underserved, impoverished U.S.-Mexico border communities.
美墨边境地区为改善医疗保健服务提供了机会；然而，对于美国边境居民（尤其是那些保险不足的居民）如何以及在何处获得医疗服务，仍存在差距。抗生素是报告中最常见的跨境医疗服务利用驱动因素之一，也是特别值得关注的药物，因为其不合理或不适当使用与抗微生物药物耐药性有关。此外，许多评估美国边境居民对墨西哥药品和医疗服务偏好的研究是在 2010 年之前进行的，当时许多处方药（包括抗生素）在墨西哥都可以在柜台购买。
本研究使用的数据来自德克萨斯州 Starr 县（得克萨斯州与墨西哥边境的 14 个县之一）正在进行的纵向队列研究的基线检查。参与者自行报告了过去 12 个月内使用过的抗生素的名称、使用日期和来源国。使用逻辑回归来确定与跨境采购抗生素相关的社会、文化和临床特征。
超过 10%的研究队列报告在过去 30 天内使用了抗生素，过去 12 个月中超过 60%的抗生素购自墨西哥。缺乏医疗保险和代际评分（一种文化适应度的衡量标准）是跨境采购抗生素的最强预测因素。
尽管墨西哥在 2010 年对处方药法规进行了改革，但之前与跨境获取抗生素相关的因素仍然存在。这些结果可用于为未来的公共卫生倡议提供信息，以便针对文化敏感的负责任抗生素管理进行教育，并解决医疗服务不足、贫困的美国-墨西哥边境社区中获取美国医疗保健和药品的障碍。
