Postdoctoral research fellow Leibniz Institute for Prevention Research and Epidemiology – BIPS Bremen, Germany
Background: Prescription rates of outpatient antibiotics were found to strongly vary across German districts, indicating overprescribing in some regions. An investigation of underlying reasons is lacking but may be helpful to improve antibiotic stewardship.
Objectives: To investigate potential factors explaining regional variation in outpatient antibiotic prescribing in Germany.
Methods: Using the German Pharmacoepidemiological Research Database (GePaRD) covering ~20% of the German population, we included persons insured in 2018. We used multilevel logistic regression analyses with individuals (first level) nested within their district of residence (second level). We investigated the association of individual (age, sex, and socioeconomic status [SES]) and regional factors (from official statistics at district level) with antibiotic prescription (at least one vs. no prescription in 2018) while assuming a random intercept by district. All analyses were performed by age group (0–6, 7–17, 18–64, and ≥65 years).
Results: Overall, the study population comprised 16,623,058 persons from 397 districts. Across all age groups, a higher district-level employment rate was associated with a higher chance of antibiotic prescription, while a higher SES, a higher rate of academic degrees in the district and a higher physician density were associated with a lower chance of antibiotic prescription. In the age group 0–6 years, the rate of preschool children at daycare facilities was positively associated with the chance of antibiotic prescription. In the age groups 7–17 and 18–64 years, the chance of antibiotic prescription was lower in rural areas than in cities. The individual factors could explain 1% (age group ≥65 years) to 6% (age group 7–17 years) of district-level variance; with additional consideration of regional factors, the models could explain 50% (age group 0–6 years) to 68% (age group ≥65 years) of regional variations in the chance of antibiotic prescription.
Conclusions: Our study showed that a considerable share of regional variations in outpatient antibiotic prescribing in Germany can be explained by socioeconomic differences. This indicates the need to design regionally tailored measures to improve rational use of antibiotics.
