Demographic and Geographic Inequities in Antimicrobial Use and Prescribing

Potential drivers of racial, ethnic, and other demographic inequities in the occurrence of health care-associated infections may occur at the interpersonal (eg, unconscious bias of health care professionals), community (eg, inequities in economic and SDoH), and policy (eg, segregation of health care through chronic underfunding of safety net facilities, insufficient research into inequities) levels, and a framework to mitigate them has been proposed.41 This framework can and should also be applied to the areas of antimicrobial stewardship and antimicrobial prescribing. This would involve, but is not limited to, raising individual awareness about and mitigating the uncon-scious biases of health care providers, addressing SDoH inequities, and expanding literature evaluating differences in prescribing, not only by patient but also by pre-scriber characteristics. This would include assessing not only the variables of race and ethnicity, age, gender, and geographical region described herein, but also other demographic and socioeconomic factors when available that have heretofore not been studied at all, such as disability status, sexuality, gender identity, preferred lan-guage, and other aspects of social vulnerability. The work described in this review is only the beginning to understand where and why these inequities in antimicrobial prescribing exist. Many studies do not primarily seek to answer questions about anti-microbial prescribing inequities by a specific characteristic, though prescribing dis-parities may be observed in their demographic analysis. And the vast majority of studies that have assessed antimicrobial prescribing by social demographics have done so in the outpatient setting; there is little information about prescribing ineq-uities in the acute care or post-acute care setting. Further research is warranted to identify drivers that promote these inequities in antimicrobial prescribing in the United States and ultimately to better understand whether these inequities impact patient outcomes in all settings of the health care continuum. Ultimately, this research should be used to both mitigate and ultimately eliminate these health inequities.