Racial/ethnic disparities in antibiotic use and healthcare utilization, United States, 2016/2018: a cross-sectional study

Antibiotic prescribing rates vary by patient race/ethnicity, with whites more likely to receive antibiotics and broader-spectrum antibiotics. However, the drivers of this disparity, and to what extent it represents antibiotic overuse or underprescribing of appropriate antibiotic treatment, remains unclear. Here, we investigate how antibiotic prescribing appropriateness varies by race/ethnicity and to what extent disparities in antibiotic use can be explained by differing rates of healthcare utilization. In data from two nationally representative healthcare utilization surveys, we found that racial/ethnic disparities in numbers of healthcare visits, not prescribers’ behavior, better explained disparities in antibiotic prescribing rates. We also found that the proportion of antibiotic prescriptions that were appropriate, potentially appropriate, or inappropriate did not vary significantly by race/ethnicity. These results suggest that whites’ higher antibiotic use is due primarily to increased healthcare utilization and that whites’ higher antibiotic use represents a mix of greater appropriate and inappropriate use. Thus, antibiotic stewardship goals should be informed by research into differing rates of antibiotic-treatable disease and healthcare seeking and access across different populations, to ensure that efforts to reduce inappropriate antibiotic overuse do not also reduce appropriate use in underserved populations.