Al Mohajer Mayar, Slusky David, Nix David, Nicodemo Catia
Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Department of Continuous Education, University of Oxford, Oxford, UK.
Antimicrob Steward Healthc Epidemiol. 2025 May 13;5(1):e110. doi: 10.1017/ash.2025.185. eCollection 2025.
Socioeconomic deprivation has been associated with antibiotic overprescription in the US; however, prior studies could not quantify a causal relationship due to endogeneity. This study examines how socioeconomic deprivation is related to the rate of antibiotic days supplied to older Medicare Part D beneficiaries, utilizing an Instrumental Variable (IV) approach.
Data from the Medicare Part D and the Social Deprivation Index (SDI) repositories were analyzed. To address potential endogeneity and omitted variable bias in the relationship between SDI and antibiotic prescribing, we used the maximum Earned Income Tax Credit as an IV. Bivariate Moran's assessed the spatial correlation between SDI and antibiotic prescribing across geographic regions. The IV analysis then examined the relationship between predicted SDI and antibiotic days supplied (ln). Linear regression models estimated associations between SDI and its components, and antibiotic days supplied, adjusting for prescriber, beneficiary, and geographic factors.
Among 161,164, there was no significant spatial dependence between SDI and antibiotic days supplied ( = 0.0656). In the IV model, a one-unit increase in SDI was associated with a 0.582 (SE = 0.164, < 0.0005) increase in antibiotic days supplied (ln). Higher unemployment and single-parent family rates were linked to increased antibiotic days supplied, while crowded housing was associated with a reduction.
This study identified that socioeconomic deprivation may influence antibiotic days supplied to Medicare Part D beneficiaries. Findings highlight the need for targeted public health interventions to address the socioeconomic factors contributing to excess antibiotic use.
在美国，社会经济剥夺与抗生素过度处方有关；然而，由于内生性问题，先前的研究无法量化因果关系。本研究采用工具变量（IV）方法，考察社会经济剥夺与老年医疗保险D部分受益人抗生素供应天数率之间的关系。
分析了医疗保险D部分和社会剥夺指数（SDI）存储库的数据。为了解决SDI与抗生素处方之间关系中的潜在内生性和遗漏变量偏差问题，我们使用最高劳动所得税抵免作为工具变量。双变量莫兰检验评估了不同地理区域SDI与抗生素处方之间的空间相关性。然后，工具变量分析考察了预测的SDI与抗生素供应天数（ln）之间的关系。线性回归模型估计了SDI及其组成部分与抗生素供应天数之间的关联，并对开处方者、受益人和地理因素进行了调整。
在161164例中，SDI与抗生素供应天数之间无显著空间依赖性（ = 0.0656）。在工具变量模型中，SDI每增加一个单位，抗生素供应天数（ln）增加0.582（标准误 = 0.164， < 0.0005）。较高的失业率和单亲家庭率与抗生素供应天数增加有关，而住房拥挤则与之减少有关。
本研究发现社会经济剥夺可能影响医疗保险D部分受益人抗生素供应天数。研究结果强调了有针对性的公共卫生干预措施的必要性，以解决导致抗生素过度使用的社会经济因素。
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