Socio-economic & demographic determinants of antibiotic prescribing patterns in NI

A Distinct Linkage Project using the Northern Ireland Longitudinal Study & HSC BSO Enhanced Prescribing Database

Fiona Johnston, Michael Rosato (NILS RSU) Kim Moylan (HSC BSO)

Presentation Outline

Background to the study

Project design & methods

Results:

(1) individual characteristics demographic socio-economic & cultural health status

(2) area-level characteristics area deprivation (NI MDM)

Key findings & implications

Background to the Study

Project Approval Criteria:• relevant to HSC aims & support public policy• longitudinal & unique• linking non-routine HSC individual data: rationale & feasibility• legal & ethical

Context of research: antibiotic (AB) prescribing patterns in NI

• public health: AB resistance = major global health threat

• socio-cultural: significant variation in AB prescribing

• population: demographic / socio-economic differences in AB consumption

• policy and practice: intervention & stewardship strategies

N.B. need targeted information for patients, practitioners & policy-makers

Antibiotic Resistance

Project Design

Study Aims

analyse antibiotic prescribing patterns by individual & area attributes

inform health policy & research on management of prescribing

Study Design

exemplar project

based on 2 data sources: NILS members linked to antibiotic prescription data held on EPD (12 months ending May 2010)

sample size: linked AB prescription data to c. 28% of NILS core sample (c. 125,000) indicator for high (70% and over) and low scanned coverage rates

Methodology

Relationship between AB prescriptions AND:

individual: demographic, cultural, health & socio-economic characteristics area attributes: deprivation and settlement classifications

Categorisation of counts of AB items (BSO advice & ARAC validated):

0: no AB prescription 1 to 2: minimal no. of prescriptions (may need 2nd as 1st didn’t work) 3 to 5: receiving items due to more than one illness 6+: potentially a higher risk group and on high levels/long-term AB use

Descriptive & regression analysis to identify patterns and test the relative importance of variables on usage

Database linkage & encryption methodology

HSC BSO Enhanced Prescribing Data

Pharmacist codes the drug items that were dispensed and these codes are keyed by

BSO data prep

2-D barcode captures all information printed on the

prescription, including prescribed drug data, plus some data not visible on

the prescription

Second 2-D barcode pre-printed on prescription gives GP information

Results

Individual and Household Characteristics

Demographic Cultural Socio-economic Health status

Area Characteristics

Area deprivation

Descriptive Analysis – Population Distribution

0

10

20

30

40

50

0-15 16-24 25-34 35-44 45-54 55-64 65-74 75+ Total

male

female

0

20

40

60

80

100

none 1-2 3-5 6+

number of antibiotic prescriptions

perc

en

t

male female

Received AB Prescription by Age & Sex

Distribution of Prescriptions by Items & Sex

Demographics: Age & Sex Mutually adjusted for Age & Sex (All, high coverage)

Sex 1 to 2 Items 3 to 5 Items 6+ Items

Male 1.00 1.00 1.00

Female 1.70 *** 2.39 *** 2.53 ***

Age

0-15 1.00 1.00 1.00

16-24 0.90 *** 0.98 1.15

25-34 0.99 1.12 *** 1.52 ***

35-44 1.02 1.31 *** 2.19 ***

45-54 1.20 *** 1.88 *** 4.10 ***

55-64 1.24 *** 2.36 *** 6.59 ***

65+ 0.76 *** 1.68 *** 5.92 ***

Demographics: Marital Status Adjusted for Age & Sex (16-74, high coverage)

Marital Status 1 to 2 Items 3 to 5 Items 6+ Items

Single 1.00 1.00 1.00

Married 1.17*** 1.13*** 1.06

Widowed/Divorced/

Separated

1.19*** 1.32*** 1.37***

Socio-Cultural: Community Background Adjusted for Age, Sex & Marital Status (16-74, high coverage)

Community Background

1 to 2 Items 3 to 5 Items 6+ Items

Catholic 1.00 1.00 1.00

Protestant 0.96 *** 0.93 *** 0.81 ***

Other 0.77 *** 0.61 *** 0.63 **

Socio-Economic: Tenure/Capital ValueModels adjusted for Age & Sex (All, high coverage)

Tenure & CV (excl. private renting)

1 to 2 Items 3 to 5 Items 6+ Items

Own Occ 200K+ 1.00 1.00 1.00

Own Occ 150 - 199,999+ 1.11 *** 1.22 *** 1.23 ** (0.004)

Own Occ 100 - 149,999+ 1.19 *** 1.32 *** 1.39 ***

Own Occ 75 - 99,999+ 1.30 *** 1.47 *** 1.57 ***

Own Occ less than 75 1.33 *** 1.60 *** 1.92 ***

Social Rented 1.34 *** 1.81 *** 2.26 ***

Demographics: Health Status Adjusted for Age, Sex & Marital Status (16-74, high coverage)

General Health 1 to 2 Items 3 to 5 Items 6+ Items

Good 1.00 1.00 1.00

Fair 1.37 *** 1.92 *** 2.59 ***

Not good 1.47 *** 2.67 *** 4.79 ***

Results

Individual and Household Characteristics

Demographic Cultural Socio-economic Health status

Area Characteristics

Area deprivation

0

1

2

3

least 2 3 4 5 6 7 8 9 most

area deprivation

rela

tive

risk

1-2 items 3-5 items 6+ items

Persons 25-74: prescribing patterns by area deprivation measure. Model adjusted for age, sex and marital status

0

1

2

3

4

5

least 1 2 3 4 5 6 7 most

personal deprivation

rela

tive

risk

1-2 items 3-5 items 6+ items

Persons 25-74: prescribing patterns by indicator of personal deprivation. Model adjusted for age, sex & marital status

Area Factors: Area Deprivation Models adjusted for Age & Sex & Marital Status (16-74, high coverage)

Area Deprivation 1 to 2 Items 3 to 5 Items 6+ Items

1 (Least Deprived) 1.00 1.00 1.00

2 1.03 1.09 1.21

3 1.04 1.10 1.20

4 1.09*** 1.20*** 1.44***

5 1.07*** 1.16*** 1.31***

6 1.14*** 1.24*** 1.50***

7 1.14*** 1.44*** 1.92***

8 1.15*** 1.32*** 1.54***

9 1.20*** 1.43*** 1.80***

10 (Most Deprived) 1.32*** 1.73*** 2.36***

Socio-economic: Person Deprivation ModelAdjusted for Age & Sex & Marital Status (25-74, high coverage)

Person Deprivation 1 to 2 Items 3 to 5 Items 6+ Items

0 (Least Deprived) 1.00 1.00 1.00

1 1.15*** 1.16 *** 1.22***

2 1.25*** 1.43*** 1.75***

3 1.28*** 1.68*** 2.14***

4 1.35*** 1.90*** 2.40***

5 1.40 *** 2.11*** 2.92 ***

6 1.49*** 2.44 *** 3.70***

7 1.48*** 2.49*** 3.40***

8 (Most Deprived) 1.45*** 2.41*** 3.92***

Ongoing analysis ….however clear patterns emerging: women; those not married; those living in deprived circumstances; and those with a Catholic comm. background all show significantly increased risks when compared with their associated reference groups.

Policy Implications:

targeted & relevant information for practitioners, campaigns & interventions patient records systematically linked: diagnostic, prescribing & laboratory data dissemination activities … ideas?

Future Research:

‘test’ project: not fine-grained information indication / mortality data qualitative analysis: practitioner attitudes & patient expectations more DLPs +++

Key Findings and Implications

Pending & Current NILS DLPs

BSO dental activity data: adolescent dental health and use of dental care services (PhD thesis) child dental health and use of dental care services (ongoing)

BSO prescribing data: pharmaco-epidemiological studies of characteristics related to; anxiolytic and anti-depressants

(pending) diabetes (pending) & anti-obesity medication (pending) antidepressant use among women of reproductive age (submitted for approval)

QARC breast screening data: variations in breast screening uptake (PhD thesis & 2 peer-reviewed papers published)

SOSCARE: social services admin data: children and families with long term and complex needs (pending)

Child Health System data (gestational age, smoking status and birth weight): lone mothers and socio-economic characteristics (pending)

Northern Ireland Cancer Registry data: individual, household and area level deprivation and cancer incidence and survival (pending)

The help provided by the staff of the Northern Ireland Longitudinal Study and the NILS Research Support Unit is acknowledged.

The NILS is funded by the Health and Social Care Research and Development Division of the Public Health Agency (HSC R&D

Division) and NISRA. The NILS-RSU is funded by the ESRC and Northern Ireland Government.

The authors alone are responsible for the interpretation of the data.

Acknowledgements

NILS Research Support Unit

Northern Ireland Statistics and Research Agency

McAuley House

Tel: 028 90 348138

Email: nils-rsu@qub.ac.uk

Website: nils-rsu.census.ac.uk

 count 0 1 to 2 3 to 5 6+  

age male female male female male female male female Total

0 to 4 12,214 10,881 3,013 3,387 306 419 28 56 30,304

3 to 5 30304 24869 7773 10130 1219 1841 157 211 76,504

16 to 44 70,614 60,521 14,847 25,105 1,966 5,413 321 941 179,728

45 to 64 35,643 30,079 10,388 14,383 2,230 4,411 614 1,351 99,099

65+ 19,475 25,293 3,867 6,637 1,131 2,605 451 1,133 60,592

Total 168,250 151,643 39,888 59,642 6,852 14,689 1,571 3,692 446,227

Frequencies Tables

 % 0 1 to 2 3 to 5 6+  

age male female male female male female male female Total

0 to 4 40.3 35.9 9.9 11.2 1.0 1.4 0.1 0.2 100.0

3 to 5 39.6 32.5 10.2 13.2 1.6 2.4 0.2 0.3 100.0

16 to 44 39.3 33.7 8.3 14.0 1.1 3.0 0.2 0.5 100.0

45 to 64 36.0 30.4 10.5 14.5 2.3 4.5 0.6 1.4 100.0

65+ 32.1 41.7 6.4 11.0 1.9 4.3 0.7 1.9 100.0

Total 37.7 34.0 8.9 13.4 1.5 3.3 0.4 0.8 100.0

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