Drivers of geographic patterns in outpatient antibiotic prescribing in the United States

Abstract

AbstractAntibiotic prescribing rates vary dramatically across regions in the United States, but the relative importance in prescribing practices versus per capita visit rates in driving this variation remain unclear. Quantifying their relative importance can aid in reducing antibiotic use. Using US medical claims data from 2015-2018 covering over 15 million privately insured adults, we conducted a regression analysis to estimate the relative contribution of outpatient visit rates and per-visit prescribing in explaining variation in outpatient antibiotic prescribing rates across metropolitan statistical areas. Variation in visit rates per capita explained more of the geographic variation in outpatient antibiotic prescribing rates than per-visit prescribing for conditions with high prescribing volume. Efforts to reduce antibiotic use may benefit from addressing the factors driving higher rates of outpatient visits, in addition to continued focus on stewardship.