Socio-economic, governance and health indicators shaping antimicrobial resistance: an ecological analysis of 30 european countries
Abstract Background Previous evidence shows that antibiotic use and antimicrobial resistance (AMR) spread are not always perfectly correlated within and between countries. We conducted an ecological analysis to evaluate how demographic, economic, governance, health, and freedom characteristics of 30...
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | Globalization and Health |
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| Online Access: | https://doi.org/10.1186/s12992-023-00913-0 |
| _version_ | 1797863188945960960 |
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| author | Andrea Maugeri Martina Barchitta Federico Puglisi Antonella Agodi |
| author_facet | Andrea Maugeri Martina Barchitta Federico Puglisi Antonella Agodi |
| author_sort | Andrea Maugeri |
| collection | DOAJ |
| description | Abstract Background Previous evidence shows that antibiotic use and antimicrobial resistance (AMR) spread are not always perfectly correlated within and between countries. We conducted an ecological analysis to evaluate how demographic, economic, governance, health, and freedom characteristics of 30 European countries contribute to antibiotic consumption and AMR. Methods Using three sources of data (World Bank DataBank, ECDC atlas, and the ESAC-Net database), we created a dataset of: 22 indicators of demographics, health, economic, governance, and freedom; AMR proportions for 25 combinations of pathogens and antibiotics; consumption of antibiotics in the community. We also computed five indexes of demographic, health, economic, governance, and freedom, and an aggregate AMR measure. Relationships between indexes, antibiotic consumption, and AMR proportions were explored using bivariate, multivariable, multivariate, and mediation analyses. Results Multivariate analysis identified three clusters of countries that mainly differed for demographic, health, governance, and freedom indexes. AMR proportion was lower in countries with better indexes (p < 0.001), but not necessarily with lower antibiotic consumption. In multivariable models including all five indexes, an increase in the governance index resulted in significant decreases of overall antibiotic consumption (p < 0.001) and AMR proportion (p = 0.006). Mediation analysis showed that the governance index had an indirect effect on AMR via reducing antibiotic consumption, which accounted only for 31.5% of the total effect. Conclusions These findings could be – at least partially – explained by the contagion theory, for which other factors contribute to high levels of AMR in countries with poor governance. As a result of this evidence, reducing antibiotic use alone is unlikely to solve the AMR problem, and more interventions are needed to increase governance efficiency at global level. |
| first_indexed | 2024-04-09T22:32:39Z |
| format | Article |
| id | doaj.art-3d503a82d4bd42deb62d2c1fe8888dc5 |
| institution | Directory Open Access Journal |
| issn | 1744-8603 |
| language | English |
| last_indexed | 2024-04-09T22:32:39Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Globalization and Health |
| spelling | doaj.art-3d503a82d4bd42deb62d2c1fe8888dc52023-03-22T12:40:45ZengBMCGlobalization and Health1744-86032023-02-0119111210.1186/s12992-023-00913-0Socio-economic, governance and health indicators shaping antimicrobial resistance: an ecological analysis of 30 european countriesAndrea Maugeri0Martina Barchitta1Federico Puglisi2Antonella Agodi3Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of CataniaDepartment of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of CataniaDepartment of Economics and Business, University of CataniaDepartment of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of CataniaAbstract Background Previous evidence shows that antibiotic use and antimicrobial resistance (AMR) spread are not always perfectly correlated within and between countries. We conducted an ecological analysis to evaluate how demographic, economic, governance, health, and freedom characteristics of 30 European countries contribute to antibiotic consumption and AMR. Methods Using three sources of data (World Bank DataBank, ECDC atlas, and the ESAC-Net database), we created a dataset of: 22 indicators of demographics, health, economic, governance, and freedom; AMR proportions for 25 combinations of pathogens and antibiotics; consumption of antibiotics in the community. We also computed five indexes of demographic, health, economic, governance, and freedom, and an aggregate AMR measure. Relationships between indexes, antibiotic consumption, and AMR proportions were explored using bivariate, multivariable, multivariate, and mediation analyses. Results Multivariate analysis identified three clusters of countries that mainly differed for demographic, health, governance, and freedom indexes. AMR proportion was lower in countries with better indexes (p < 0.001), but not necessarily with lower antibiotic consumption. In multivariable models including all five indexes, an increase in the governance index resulted in significant decreases of overall antibiotic consumption (p < 0.001) and AMR proportion (p = 0.006). Mediation analysis showed that the governance index had an indirect effect on AMR via reducing antibiotic consumption, which accounted only for 31.5% of the total effect. Conclusions These findings could be – at least partially – explained by the contagion theory, for which other factors contribute to high levels of AMR in countries with poor governance. As a result of this evidence, reducing antibiotic use alone is unlikely to solve the AMR problem, and more interventions are needed to increase governance efficiency at global level.https://doi.org/10.1186/s12992-023-00913-0AntibioticAntimicrobialResistanceSocial factorsEconomicGovernance |
| spellingShingle | Andrea Maugeri Martina Barchitta Federico Puglisi Antonella Agodi Socio-economic, governance and health indicators shaping antimicrobial resistance: an ecological analysis of 30 european countries Globalization and Health Antibiotic Antimicrobial Resistance Social factors Economic Governance |
| title | Socio-economic, governance and health indicators shaping antimicrobial resistance: an ecological analysis of 30 european countries |
| title_full | Socio-economic, governance and health indicators shaping antimicrobial resistance: an ecological analysis of 30 european countries |
| title_fullStr | Socio-economic, governance and health indicators shaping antimicrobial resistance: an ecological analysis of 30 european countries |
| title_full_unstemmed | Socio-economic, governance and health indicators shaping antimicrobial resistance: an ecological analysis of 30 european countries |
| title_short | Socio-economic, governance and health indicators shaping antimicrobial resistance: an ecological analysis of 30 european countries |
| title_sort | socio economic governance and health indicators shaping antimicrobial resistance an ecological analysis of 30 european countries |
| topic | Antibiotic Antimicrobial Resistance Social factors Economic Governance |
| url | https://doi.org/10.1186/s12992-023-00913-0 |
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