Impact of Geodemographic Factors on Antibiotic Prescribing for Acute, Uncomplicated Bronchitis or Upper Respiratory Tract Infection

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Table 1.

Patient Demographics and Characteristics for Those Prescribed and Not Prescribed Antibiotics

Variable, N (%)^*	Overall (n = 63,051)	Never Prescribed (n = 30,194)	Prescribed (n = 32,857)	P value
Race/ethnicity
White non-Hispanic	49,619 (78.7)	23,126 (76.6)	26,493 (80.6)	<0.001
Black non-Hispanic	6,965 (11.1)	3,469 (11.5)	3,496 (10.6)
Hispanic	4,665 (7.4)	2,647 (8.8)	2,018 (6.1)
Asian	1,164 (1.9)	619 (2.1)	545 (1.7)
Other	638 (1.0)	333 (1.1)	305 (0.9)
Patient over 65	12,338 (19.6)	5,078 (16.8)	7,260 (22.1)	<0.001
Male	23,493 (37.3)	10,762 (35.6)	12,731 (38.8)	<0.001
Ever smoker	27,422 (43.5)	12,453 (41.2)	14,969 (45.6)	<0.001
BMI categories
Underweight	736 (1.2)	335 (1.1)	401 (1.2)	0.310
Normal weight	9,207 (14.6)	4,274 (14.2)	4,933 (15.0)
Overweight	13,151 (20.9)	5,979 (19.8)	7,171 (21.8)
Obese	23,077 (36.6)	10,447 (34.6)	12,630 (38.4)
Missing	16,880 (26.8)	9,159 (30.3)	7,721 (23.5)
Insurance type
Private	34,030 (54.0)	15,897 (52.7)	18,133 (55.2)	<0.001
Medicaid	8,401 (13.32)	4,881 (16.2)	3,520 (10.7)
Medicare	14,998 (23.8)	6,295 (20.9)	8,703 (26.5)
Exchange	2,316 (3.7)	1,131 (3.8)	1,185 (3.6)
Other	162 (0.3)	82 (0.3)	80 (0.2)
Missing	3,144 (5.0)	1,908 (6.3)	1,236 (3.8)
Provider type
Physician	41,899 (66.5)	20,502 (67.9)	21,397 (65.1)	<0.001
Nurse practitioner	11,446 (18.2)	5,195 (17.2)	6,251 (19.0)
Physician assistant	9,441 (15.0)	4,378 (14.5)	5,063 (15.4)
Other provider type	265 (0.4)	119 (0.4)	146 (0.4)
Location of visit
Emergency department, N (%)	5,955 (9.4)	4,203 (13.9)	1,752 (5.3)	<0.001
Urgent care, N (%)	36,109 (57.3)	16,174 (53.6)	19,935 (60.7)
Clinic, N (%)	20,987 (33.3)	9,817 (32.5)	11,170 (34.0)

↵* All data are presented as the number (percentage) for that variable, binary or categorical, within each column: overall, never prescribed and prescribed.
Abbreviation: BMI, body mass index.

Table 2.

Continuous Variable Comparison for Those Prescribed and Not Prescribed Antibiotics^*

Variable	Overall (n = 63,051)	Never Prescribed (n = 30,194)	Prescribed (n = 32,857)	p-Value
Patient age, years	63,051 (48.4 ± 18.2)	30,194 (45.8 ± 18.4)	32,857 (50.8 ± 17.7)	<0.001
Time to room, minutes	55,778 (14.2 ± 16.4)	25,242 (13.4 ± 15.6)	30,536 (14.8 ± 17.0)	<0.001
Time in room, minutes	55,699 (30.0 ± 19.3)	25,203 (31.4 ± 19.4)	30,496 (28.8 ± 19.0)	<0.001
Respiratory rate, beats per minute	38,441 (17.2 ± 2.6)	17,567 (17.2 ± 2.6)	20,874 (17.3 ± 2.6)	0.068
Systolic blood pressure, mm Hg	53,218 (124.8 ± 14.5)	24,171 (124.7 ± 14.6)	29,047(124.8 ± 14.5)	0.512
Diastolic blood pressure, mm Hg	53,430 (75.9 ± 9.8)	24,274 (75.8 ± 9.8)	29,156 (75.9 ± 9.8)	0.786
Temperature, degrees Fahrenheit	53,405 (98.3 ± 0.7)	24,340 (98.3 ± 0.7)	29,065 (98.3 ± 0.7)	0.969
Heart rate, beats per minute	55,224 (82.5 ± 14.3)	25,101 (82.4 ± 14.3)	30,123 (82.6 ± 14.3)	0.031
Median age housing^{^a}, years	61,272 (40.7 ± 8.4)	29,342 (40.4 ± 8.5)	31,930 (41.0 ± 8.3)	<0.001
Owner occupied housing^{^a}, percent	61,272 (66.1 ± 24.2)	29,342 (64.5 ± 24.6)	31,930 (67.7 ± 23.7)	<0.001
Households without vehicles^{^a}, percent	61,272 (7.3 ± 9.6)	29,342 (7.9 ± 10.0)	31,930 (6.9 ± 9.1)	<0.001
Distance from clinic, miles	61,233 (10.0 ± 20.8)	29,312 (10.0 ± 21.9)	31,921 (9.9 ± 19.8)	0.414

↵* Data indicate the number of patients who have a given characteristic as well as the mean ± standard deviation for that variable: among the overall population, among those never prescribed an antibiotic and among those prescribed an antibiotics.
↵a Median age of housing, owner occupied housing, and households without vehicles per block group as collected annually by the American Community Survey.

Table 3.

Association Between Patient, Prescriber, Facility, Geographic, and Socioeconomic Characteristics and Antibiotic Prescribing

Variable	Adjusted Odds Ratio Estimates	95% Confidence Interval
Black race/ethnicity^{^a,^b}	1.29	1.22, 1.38
Hispanic race/ethnicity^{^a,^b}	0.94	0.87, 1.00
Asian race/ethnicity^{^a,^b}	0.88	0.77, 0.99
Other race/ethnicity^{^a,^b}	0.87	0.73, 1.04
Male	1.10	1.06, 1.14
Patient age	1.02	1.02, 1.02
Smoking	1.18	1.14, 1.23
Median age housing, years	1.00	1.00, 1.00
Owner occupied housing percent	1.41	1.30, 1.53
Medicaid insurance^{^a,^c}	0.84	0.79, 0.89
Medicare insurance^{^a,^c}	0.83	0.78, 0.87
Exchange insurance^{^a,^c}	0.90	0.82, 0.98
Other insurance^{^a,^c}	0.98	0.71, 1.36
Emergency department setting ^{^a,^d}	0.43	0.40, 0.46
Urgent care setting^{^a,^d}	1.26	1.22, 1.31

Table 4.

Percentage Comparisons of Patient Demographics in Present Study to US Census 2020 and National Ambulatory Medical Care Survey (NAMCS) 2018 Data

Variable, %	Present Study	2020 Census³¹	NAMCS³²
Race/ethnicity
White non-Hispanic	78.7	60.1	70.3
Black non-Hispanic	11.1	13.4^*	7.6
Hispanic	7.4	18.5	14.9
Patient over 65	19.6	16.5	32.7
Male	37.3	49.2	41.1
Insurance type
Private	54.0	—	57.0
Medicaid	13.3	—	12.9
Medicare	23.8	—	27.7

Appendix Table.

Diagnosis Codes of Interest

ICD-10 Code
J20.0 Acute bronchitis due to Mycoplasma pneumoniae
J20.1 Acute bronchitis due to Hemophilus influenza
J20.2 Acute bronchitis due to streptococcus
J20.3 Acute bronchitis due to coxsackievirus
J20.4 Acute bronchitis due to parainfluenza virus
J20.5 Acute bronchitis due to respiratory syncytial virus
J20.6 Acute bronchitis due to rhinovirus
J20.7 Acute bronchitis due to echovirus
J20.8 Acute bronchitis due to other specified organisms
J20.9 Acute bronchitis, unspecified
J40 Bronchitis, not specified as acute or chronic
J06.9 Acute upper respiratory infection, unspecified
J00 Acute nasopharyngitis [common cold]