RT Journal Article
SR Electronic
T1 Chronic diseases and variations in rates of antimicrobial use in the community: a population-based analysis of linked administrative data in Quebec, Canada, 2002–2017
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E831
OP E840
DO 10.9778/cmajo.20210258
VO 10
IS 3
A1 Fortin, Élise
A1 Sirois, Caroline
A1 Quach, Caroline
A1 Jean, Sonia
A1 Simard, Marc
A1 Dionne, Marc
A1 Irace-Cima, Alejandra
A1 Magali-Ufitinema, Nadine
YR 2022
UL http://www.cmajopen.ca/content/10/3/E831.abstract
AB Background: Chronic diseases may increase risk of infection and complications from infections; fear of these risks may lower clinicians’ tolerance threshold for the prescription of antimicrobials, thus increasing the risk of selecting resistant bacteria. We sought to describe rates of antimicrobial use in Quebec and measure the association between chronic diseases and utilization rates.Methods: Using the Quebec Integrated Chronic Disease Surveillance System, we analyzed data of people covered by the public drug insurance plan in 2002–2017. Based on delivered prescriptions, we described trends in antimicrobial use in the population, and per category of select chronic diseases (i.e., none, respiratory, cardiovascular, diabetes, mental disorder), according to age group (0–17 yr, 18–64 yr and ≥ 65 yr). We computed ratios of extended-to-narrow–spectrum antimicrobials in 2014–2017. We used robust Poisson regression to quantify the association between chronic diseases and rates of antimicrobial use among children and adults (≥ 18 yr).Results: Between 2002 and 2017, 4 231 724 prescriptions were received over 6 653 473 individual-years among children; 1 367 492 (20.6%) individual-years had at least 1 chronic disease. Among adults aged 18–64 years, 13 365 577 prescriptions were received over 24 935 592 individual-years; 9 533 493 (38.2%) individual-years had at least 1 chronic disease. Among adults 65 years or older, 11 689 365 prescriptions were received over 15 927 342 individual-years; 12 743 588 (80.0%) individual-years had least 1 chronic disease. Antimicrobial use decreased among children, remained stable among younger adults and increased among older adults. Trends were consistent across chronic disease categories in children and older adults. In 2014–2017, 19.9% of children, 39.1% of younger adults and 79.7% of older adults had at least 1 chronic disease. Claims for extended-spectrum antimicrobials were frequent in all age and chronic disease groups, relative to narrow-spectrum antimicrobials (ratios from 3.1:1 to 14.6:1). Antimicrobial use was higher among people with respiratory diseases (adults: relative rate [RR] 2.09, 95% confidence interval [CI] 2.07–2.10; children: RR 1.62, 95% CI 1.59–1.65), mental health diagnoses (adults: RR 1.48, 95% CI 1.46–1.49; children: RR 1.22, 95% 1.20–1.24), diabetes (adults: RR 1.40, 95% CI 1.28–1.41; children: RR 2.02, 95% CI 1.58–2.57) and cardiovascular diseases (adults: RR 1.31, 95% CI 1.30–1.32), compared with those with none of the studied chronic diseases.Interpretation: During the study period, large proportions of antimicrobial prescriptions were for people with chronic diseases, across the age spectrum. Interventions to reduce antimicrobial use should be tailored for these populations.See related research article by Fortin and colleagues at www.cmajopen.ca/lookup/doi/10.9778/cmajo.20210257