Infection Control & Hospital Epidemiology


Table 1. Percentage of Members with ≥1 Antibiotic Dispensing per Year by Demographic Characteristic and Select Comorbidity (Total per Category) Variable


2000 Total, % (no.)


Sex, % (no.) Female Male


Age, % (no.) 0–4 y


5–19 y


20–49 y ≥50 y


Race, % (no.) Black White Asian


Amer. Indian/ Alaskan Native Native Hawaiian/ Pac. Islander Unknown Hispanic


Not Hispanic


Comorbidity, % (no.) No comorbidity


Severe/moderate liver disease Chronic pulmonary disease Diabetes Cancerb


Renal diseasec 33.3% (1,227,065)


37.0 (643,492) 29.1 (583,573)


45.3 (79,462) 33.9 (258,883) 30.8 (596,633) 34.5 (292,061)


32.8 (8,763) 39.7 (93,193) 29.2 (3,200) 45.8 (225) 34.1 (82)


32.8 (1,121,602) 37.3 (3,527)


38.8 (105,260)


NAa NAa NAa NAa NAa NAa


2004 31.5% (936,069)


35.4 (485,290) 27.4 (450,779)


39.5 (60,524) 30.4 (196,686) 29.2 (439,898) 34.8 (238,948)


32.4 (11,877) 37.6 (128,024) 26.3 (5,500) 36.9 (293) 35.2 (105)


30.6 (790,270) 35.5 (5,693)


36.7 (145,581)


28.1 (799,066) 60.3 (471)


56.4 (72,631) 48.5 (41,469) 53.3 (26,115) 58.7 (3,835)


2008 31.5% (910,277)


35.2 (470,495) 27.6 (439,782)


37.4 (53,761) 30.4 (188,444) 29.0 (430,293) 34.8 (237,768)


28.1 (17,971) 37.1 (200,026) 22.9 (11,080) 39.7 (532) 33.0 (185)


30.1 (680,483) 32.2 (9,658)


35.7 (229,531)


28.1 (777,288) 62.9 (542)


56.4 70,161) 47.9 (42,373) 52.5 (3,904) 58.2 (4,873)


2012 28.8% (949,413)


32.3 (488,750) 25.2 (460,663)


33.7 (51,336) 28.4 (192,827) 26.7 (416,366) 31.3 (288,879)


25.7 (16,591) 32.8 (202,137) 20.6 (10,671) 35.7 (616) 31.0 (200)


27.9 (719,198) 30.0 (9,885)


31.8 (230,358)


25.8 (799,553) 61.7 (708)


49.9 (75,249) 42.6 (50,993) 46.6 (29,474) 48.1 (8,449)


373


2016 25.9% (1,089,185)


29.3 (559,390) 22.3 (529,795)


31.8 (48,691) 26.3 (180,718) 24.5 (471,200) 26.6 (388,574)


23.2 (14,208) 30.5 (176,343) 19.4 (9,060) 32.1 (617) 32.2 (202)


25.1 (888,755) 26.5 (8,295)


29.5 (199,039)


23.2 (907,210) 53.2 (955)


45.0 (82,907) 35.7 (66,585) 37.8 (37,793) 35.6 (15,102)


a1 year of enrollment history was used to assess the presence of diagnosis codes for the comorbidities; 2000 was the first year of data accessed. bIncludes malignancy (except skin) and metastatic solid tumor. cThe increase in the number of members with evidence of renal disease is substantial and has been observed and commented on by others10 using other data sources due to changes in clinical classifications.


antibiotic and 46.4% of those with hemiplegia or paraplegia received at least 1 antibiotic. At the low end of the range, 35.7% of those with diabetes received at least 1 antibiotic and 31.0% with dementia received at least 1 antibiotic. The most frequently dis- pensed antibiotics in 2016 were penicillins (34.3%), followed by macrolides (19.7%) and cephalosporins (12.2%). In the sensitivity analysis, which was restricted tomembers con-


tinuously enrolled from 2000 to 2016, we detected a similar decrease in antibiotic utilization. With an average of 62,486 mem- bers enrolled each year, the percentage of members receiving anti- biotics decreased from 43.9% in 2000 to 33.8% in 2016. The trend was again consistent in all strata of age, sex, race, and Hispanic ethnicity.


Fig. 1. Percentage ofmembers with and without outpatient antibiotic dispensings per year, by number of dispensings (2000–2016).


(29.3% vs 22.3%). Antibiotics were more commonly dispensed to patients with comorbidities (31.0%–53.2%) versus those without (23.2%). The proportion with ≥1 antibiotic dispensed in 2016 var- ied by comorbidity; for example, at the high end of the range, 53.2% of patients with severe or moderate liver disease received at least 1


Discussion


This descriptive analysis reveals a meaningful and sustained decrease in the annual fraction of patients receiving antibiotics over a 17-year period. These findings were consistent across all strata of age, sex, race/ethnicity, and comorbidities. Further- more, a sensitivity analysis restricted to people continuously enrolled for the entire study period showed similar decreases in antibiotic prescriptions. The proportion of continuously


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