Abstract
Background
The relationship between socioeconomic factors and ABR remains a knowledge gap in China. In this study, our aim was to examine the association between ABR proportion and socioeconomic factors across 30 provinces in mainland China.
Methods
We used two measures of ABR: the proportion of carbapenem-resistant Pseudomonas aeruginosa (CRPA), 3rd generation cephalosporin-resistant Klebsiella pneumoniae (3GCRKP), 3rd generation cephalosporin-resistant Escherichia coli (3GCREC), methicillin-resistant Staphylococcus aureus (MRSA); and the aggregate resistance. ABR proportion, education, gross domestic product (GDP) per capita, out-of-pocket (OOP) health expenditure, physician density, hospital bed density, access to water source, and number of public toilets per 10,000 population data during 2014 and 2018 in 30 provinces in mainland China were included. We examined the association between ABR level and potential contributing factors using panel data modelling. In addition, we explored this relationship from eastern, central, and western economic zone, respectively.
Results
Our results indicated that higher hospital bed density and physician density were significantly associated with lower levels of ABR. The issue of ABR was also related to socioeconomic factors such as GDP per capita, OOP health expenditure, education, which might depend on different resistant bacteria or different economic zones. GDP per capita was negatively associated with CRPA level, but positively associated with MRSA level. Higher OOP health expenditure was associated higher CRPA level. In addition, we only found that ABR prevalence was significantly negatively associated with education, and positively associated with OOP health expenditure in central economic zone, but not found in eastern and western economic zone.
Conclusions
Our study highlights that measures increasing hospital beds and physicians allocation to curb ABR should be implemented. Besides, intervention measures tackling the development and spread of ABR in China must better recognize and address the importance of social and economic determinants.