Influence of provider and urgent care density across different socioeconomic strata on outpatient antibiotic prescribing in the USA

Eili Y. Klein, Michael Makowsky, Megan Orlando, Erez Hatna, Nikolay P. Braykov, Ramanan Laxminarayan

Research output: Contribution to journalArticlepeer-review


Objectives: Despite a strong link between antibiotic use and resistance, and highly variable antibiotic consumption rates across the USA, drivers of differences in consumption rates are not fully understood. The objective of this study was to examine how provider density affects antibiotic prescribing rates across socioeconomic groups in the USA. Methods: We aggregated data on all outpatient antibiotic prescriptions filled in retail pharmacies in the USA in 2000 and 2010 from IMS Health into 3436 geographically distinct hospital service areas and combined this with socioeconomic and structural factors that affect antibiotic prescribing from the US Census. We then used fixedeffect models to estimate the interaction between poverty and the number of physician offices per capita (i.e. physician density) and the presence of urgent care and retail clinics on antibiotic prescribing rates. Results:We found large geographical variation in prescribing, driven in part by the number of physician offices per capita. For an increase of one standard deviation in the number of physician offices per capita there was a 25.9% increase in prescriptions per capita. However, the determinants of the prescription ratewere dependent on socioeconomic conditions. In poorer areas, clinics substitute for traditional physician offices, reducing the impact of physician density. In wealthier areas, clinics increase the effect of physician density on the prescribing rate. Conclusions: In areas with higher poverty rates, access to providers drives the prescribing rate. However, in wealthier areas, where access is less of a problem, a higher density of providers and clinics increases the prescribing rate, potentially due to competition.

Original languageEnglish (US)
Pages (from-to)1580-1587
Number of pages8
JournalJournal of Antimicrobial Chemotherapy
Issue number5
StatePublished - Oct 20 2014


  • Antibiotic resistance
  • Pharmacoepidemiology
  • Public health

ASJC Scopus subject areas

  • Microbiology (medical)
  • Pharmacology (medical)
  • Infectious Diseases
  • Pharmacology


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