Study: Wealthier People Get More Antibiotics

By Jane Farrell

Doctors, retail medical clinics and urgent care centers appear to be locked in a battle for patients, and that means they’re prescribing increasing numbers of antibiotics, according to a team led by Johns Hopkins researchers.

“We found that both the number of physicians per capita and the number of clinics are significant drivers of antibiotic prescription rate,” the researchers say in a report on the findings published in the Journal of Antimicrobial Chemotherapy.

“The increase in the number of antibiotic prescriptions written in wealthy areas appears to be driven primarily by increased competition among doctors’ offices, retail medical clinics and other health care providers as they seek to keep patients satisfied with medical care and customer service,” says lead study author Eili Klein, Ph.D., an assistant professor of emergency medicine in the Johns Hopkins University School of Medicine and a member of the Johns Hopkins Center for Advanced Modeling in the Social, Behavioral and Health Sciences.

According to the study, the highest rate of antibiotic prescriptions occurred in the southeastern U.S. and along the West and East coasts.  Other high prescription rates occurred in Manhattan, southern Miami and Encino, California, among other areas. Overall, the researchers’ analysis revealed highly variable prescription rates across the United States.

In wealthy areas, the researchers said, presence of clinics correlated to an increase in the prescribing rate of physicians.

But while the presence of retail or urgent care clinics in poorer areas increased access to health care, it did not generate competition among providers that resulted in higher prescribing behavior by physicians’ offices, according to a news release from Johns Hopkins.

The researchers said that conclusions add to the growing evidence that social and economic factors contribute to the overuse of antibiotics in the United States. The overuse of antibiotics is a major cause of a worldwide health threat, because it helps in the spread of antibiotic resistance.

“We were surprised to find in this study that there is a really strong suggestion in the data that physicians are competing with other physicians, and they are doing that through the mechanism of prescribing antibiotics,” says Klein.

“It speaks to the fact that health care is a business,” he adds. “But it also underscores that there is a lot of pressure on doctors to prescribe antibiotics — even when they aren’t 100 percent certain they are necessary.”