This post is part of a series recognizing Antimicrobial Awareness Week 2024. Research Digest is a periodic installment that recognizes the world-class clinical research performed right here at UNMC ID. Today, we review four articles covering the intersection of health equity and antimicrobial resistance/stewardship. As always, check out the linked full articles for more details.
In the first article, Dr. Catherine Cichon (prior UNMC ID fellow) and Dr. Jasmine R. Marcelin, among others at UNMC, have reviewed existing data on health inequities. Recent studies have shown variable antimicrobial prescribing patterns and adverse events across race/ethnicity, rural or urban locations, and socioeconomic status. While these determinants of health outcomes have been described with respect to antimicrobial stewardship, there has been little effort to identify the driving factors of these disparities, a topic on which the review provides context, suggested next steps, and a call to action within the research community to identify and directly address the root causes of inequity pertaining to antimicrobial medications. Read the full article here.
The second article, also co-authored by Dr. Marcelin, dives into this issue by performing a scoping review of articles between 2000 and 2022 to characterize antibiotic prescribing practices. The authors identified significant differences across patient’s race and ethnicity, sex, age, socioeconomic factors, geography, clinician’s age and specialty, and healthcare setting, with an emphasis on the outpatient setting. These disparities contribute to healthcare inequality in profound ways. The authors conclude that future research should include specific health equity-related objectives to improve our understanding of the causes, effects, and interventions that may successfully correct inequity in the future. There is much nuance surrounding these findings, which is addressed in detail in this article. Read here for the full story.
Given the evidence explored in the first two articles, there is a great need to address antimicrobial stewardship through the lens of health equity. The third and fourth articles, written by Dr. Marcelin as well, define the interaction between social determinants of health and infectious disease health disparities, including in regard to antimicrobial stewardship. Crucially, these articles also provide actionable advice and steps to address disparities. The first article addresses this from an individual, organizational, and public health system level, while the second provides ample examples of detailed priorities that are aimed at aiding the implementation of strategies to address inequity in infectious disease. This is a fantastic resource for ID professionals everywhere and narratively describes and advises on the topic of health equity and infectious disease outcomes. Read the full articles here and here.
For a comprehensive approach to this important topic, check out the Society for Healthcare Epidemiology of America (SHEA)/CDC Advancing Health Equity through Antimicrobial Stewardship Workshop.