Description
- Abstract:
- Correlation of Antimicrobial Prescription Rate and Socioeconomic Status- Background: Excessive antimicrobial agent usage plays a key role in antimicrobial resistance. Objective: To examine whether socioeconomic status has an impact on the likelihood of being prescribed an antimicrobial agent. Design: Cross-sectional study. Setting: United States, 2015. Data Sources: We used combined data from Medicare Part D Public Use File (PUF) and the US Census Bureau. The 2015 Medicare Part D PUF data quantified the antimicrobial prescription rate in a county level cross-sectional study while data from the US Census Bureau provided information on socioeconomic status at the county level. Study Selection: The analysis of this study included counties in the United States who had available data containing information on levels of income and the number of antimicrobial agents prescribed. In total, we gathered data from 807 counties. Main Outcomes and Measures: The primary outcome variable was percentage of antimicrobial agent claims from the medical prescriber. All original and refill antimicrobial prescription claims included in the Medicare Part D PUF were used in this study. Results: We analyzed 54,382,436 outpatient antimicrobial prescription claims from 36 million Medicare Part D recipients. Interestingly, at the county level, 48% of the variance in antimicrobial rate was explained by socioeconomic status, age, gender, and race (Pmodel <0.001, R2 = 0.48). More specifically, 26% of the variance in antimicrobial rate was explained by socioeconomic status (Pmodel <0.001, R2 = 0.26) and a trend was noted revealing that as income increased, correlation with antimicrobial prescription rate decreased. This trend was evident given a downward trend in coefficient values for our ascending income brackets. We noted that a 1 SD increase in percentage of individuals in the income bracket of $24,999 or less in a given county yielded a 0.21 increase in total antimicrobial prescription rate. This was compared to those in our highest income bracket (≥$65,000), where a 1 SD increase yielded an increase of 0.11 in antimicrobial prescription rate. Multivariable analysis including sociodemographics (age, % male, % white) revealed a significant negative relationship between our highest income bracket and the rate of antimicrobial agents prescribed. Age, gender, and race, were also associated with antimicrobial prescription rate. An increase of 1 SD in percentage of persons in the age 18-24 bracket in a given county yielded a 0.76 increase in rate of antimicrobial prescription. Moreover, a 1 SD increase in percentage of males in a county were found to have a -0.2 decrease in antimicrobial prescription rate while an increase of 1 SD in percentage of individuals of white race in a county were found to have a 0.35 increase in antimicrobial prescription rate. Conclusions and Relevance: Socioeconomic factors influence the prescription of antimicrobial agents. Interventions should consider these factors in order to effectively evaluate antimicrobial prescription methods. The role of socioeconomic status on brand-name vs. generic drug prescriptions: A county-level, U.S.-wide analysis based in Medicare Part D claims- Background: Brand-name drugs lead to higher health care expenditures nationally. Objective: To determine whether socioeconomic parameters impact brand-name drug prescription patterns among several medical specialties with high brand-name outpatient prescription patterns. Design: Cross-sectional. Setting: United States, 2015. Data Sources: We used combined data from the US Census Bureau and Medicare Part D Public Use File. Data from the US Census bureau provided information on socioeconomic status while the 2015 Medicare Part D Public Use File quantified the brand-name prescription claims in a county level cross-sectional study. Methods: The analysis included counties in the United States who had available data containing information on income, the number of brand-name drugs prescribed, and whether a county had the medical specialty of interest. Depending on the specialty, we gathered data from around 1,077-2,907 counties. Income was broken down into four ascending brackets of income levels and served as our variable for socioeconomic status. Univariable analysis also included regressions involving age, gender, and race. Main Outcomes and Measures: The primary outcome variable was percentage of brand-name claims from a medical prescriber. All original and refill claims included in the Medicare Part D Public Use File were used in this study. Results: We analyzed 3,821,523 brand-name claims and 14,088,613 generic claims reported by health providers from 40 specialties as provided by the 2015 Medicare Part D dataset. Internal Medicine, Family Practice, General Practice, Cardiology, and Ophthalmology accounted for 71% of the total amount of brand-name drugs prescribed under Medicare Part D in 2015. At the county level, univariable analysis revealed that an income of $100,000 or more was significantly associated with a larger number of brand-name drugs prescribed for these five specialties (R2 = 0.003-0.08). As the presence of individuals with an income $100,000 increased in a given county, the likelihood of receiving a brand-name prescription claim increased (R2 = 0.01-0.12). Other parameters, such as percent of non-White population and percent of individuals 18 to 64 or 65 years old had a smaller impact. The influence of these sociodemographics was highest in Cardiology where 12% of the county level variance in brand-name prescription claims among cardiologists was associated with an income $100,000, an age of 18 to 64, and a race of ‘Other’ (Pmodel < 0.001, R2 = 0.12). Conclusions and Relevance: At a county level, socioeconomic factors, in addition to other sociodemographics, influence outpatient brand-name drug prescription patterns. Future interventions should consider these factors in order to reduce number of brand-name drugs prescribed and decrease health care expenditures.
- Notes:
- Thesis (M. P. H.)--Brown University, 2018
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Citation
Volpi, Connor Ryan,
"Correlation of Antimicrobial Prescription Rate and Socioeconomic Status and The role of socioeconomic status on brand-name vs. generic drug prescriptions: A county-level, U.S.-wide analysis based in Medicare Part D claims"
(2018).
Public Health Theses and Dissertations.
Brown Digital Repository. Brown University Library.
https://doi.org/10.26300/2vm7-vn19
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Public Health Theses and Dissertations
Theses and Dissertations for the Public Health department....