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Table 4 Factors associated with an antibiotic prescription issued within 3 days of ALRTIa episode in patients without asthmab

From: Use of antibiotics and asthma medication for acute lower respiratory tract infections in people with and without asthma: retrospective cohort study

 

No antibiotics, n (%)

Antibiotics, n (%)

Univariate analysis

Full model

OR (95% CI)

p-value

OR (95% CI)

p-value

  

11,592 (20.1)

44,706 (79.4)

    

Demographic factors

 Gender

Male

4339 (37.4)

18,589 (41.6)

1 (ref)

 

1 (ref)

 

Female

7253 (62.6)

26,117 (58.4)

0.84 (0.81, 0.88)

< 0.001

0.82 (0.76, 0.88)

< 0.001

 Age at ALRTI (years) c

per SD

  

0.90 (0.88, 0.92)

< 0.001

1.00 (0.96, 1.04)

0.87

 IMD quintile

1 (Least)

2202 (19.0)

9737 (21.8)

1 (ref)

 

1 (ref)

 

2

2164 (18.7)

9275 (20.8)

0.95 (0.88, 1.02)

 

0.99 (0.88, 1.12)

 

3

2257 (19.5)

8824 (19.7)

0.87 (0.81, 0.94)

 

0.94 (0.83, 1.05)

 

4

2341 (20.2)

8321 (18.6)

0.79 (0.73, 0.85)

 

0.90 (0.80, 1.01)

 

5 (Most)

2628 (22.7)

8549 (19.1)

0.75 (0.69, 0.81)

< 0.001

1.01 (0.89, 1.15)

0.21

 Smoking status

Never

4363 (37.6)

17,652 (39.5)

1 (ref)

 

1 (ref)

 

Current

6220 (53.7)

20,966 (46.9)

0.84 (0.81, 0.88)

 

1.00 (0.93, 1.08)

 

Previous

1009 (8.7)

6085 (13.6)

1.51 (1.40, 1.63)

< 0.001

1.19 (1.05, 1.34)

0.01

Clinical factors

 Season of infection

Summer

4391 (37.9)

15,994 (35.8)

1 (ref)

 

1 (ref)

 

Winder

7201 (62.1)

28,712 (64.2)

1.10 (1.05, 1.15)

< 0.001

1.06 (0.98, 1.14)

0.14

 Prescribed asthma medication d

No

10,548 (91.0)

37,436 (83.7)

1 (ref)

 

1 (ref)

 

Yes

1044 (9.0)

7270 (16.3)

2.11 (1.97, 2.27)

< 0.001

1.04 (0.94, 1.15)

0.43

 Number of ALRTI in prior 12 months

0

7440 (64.2)

42,027 (94.0)

1 (ref)

 

1 (ref)

 

1

3131 (27.0)

2318 (5.2)

0.13 (0.12, 0.14)

 

0.24 (0.21, 0.27)

 

2+

1021 (8.8)

361 (0.8)

0.06 (0.05, 0.07)

< 0.001

0.16 (0.13, 0.20)

< 0.001

 Multimorbidity score e

0

6998 (60.4)

16,143 (36.1)

1 (ref)

 

1 (ref)

 

1

1626 (14.0)

11,484 (25.7)

3.14 (2.96, 3.33)

 

1.15 (1.05, 1.27)

 

2

1176 (10.1)

7513 (16.8)

2.87 (2.68, 3.08)

 

1.09 (0.97, 1.21)

 

3+

1792 (15.5)

9566 (21.4)

2.45 (2.31, 2.60)

< 0.001

0.96 (0.86, 1.07)

< 0.001

 Number of antibiotics prescribed in previous 12 months f

0

8636 (74.5)

532 (1.2)

0.004 (0.003, 0.004)

 

0.006 (0.005, 0.006)

 

1

1584 (13.7)

24,577 (55.0)

1 (ref)

 

1 (ref)

 

2

659 (5.7)

10,163 (22.7)

0.99 (0.90, 1.09)

 

1.16 (1.05, 1.28)

 

3+

713 (6.2)

9434 (21.1)

0.86 (0.78, 0.94)

< 0.001

1.35 (1.21, 1.49)

< 0.001

Practice factors

 Practice ALRTI antibiotic rates (per 1000 patients) c

per SD

  

1.47 (1.44, 1.5)

< 0.001

1.45 (1.39, 1.52)

< 0.001

  1. OR Odds ratio, CI Confidence interval, SD Standard deviation, ref reference
  2. Models restricted to participants with complete information on all variables included in the full model. Multi-level logistic regression models were used, with general practice included as a random effect to account for clustering. Coefficients represent the odds of receiving antibiotic prescription for a unit increase in the exposure of interest. Antibiotics prescribed within 3 days of ALRTI, and includes amoxicillin, doxycycline, clarithromycin, co-amoxiclav, azithromycin, erythromycin, tetracycline, cefalexin, and cefradine
  3. a Acute lower respiratory tract infection
  4. b Defined as ever diagnosed and asthma medication prescribed in the 12 months prior to ALRTI
  5. c Age at index infection and practice ALRTI antibiotic rates standardised (using sample mean values and SDs), and coefficients represent a change in the OR in antibiotic prescribing per 1-standard deviation increment in exposure of interest
  6. d Asthma medication refers to a prescription for any asthma medication. Asthma medication includes long- and short-acting β2 agonists, leukotriene receptor antagonists, antimuscarinic bronchodilators, and inhaled and oral corticosteroids
  7. e A list of 37 physical and mental chronic conditions were used to ascertain multimorbidity status in participants at ALRTI diagnosis
  8. f Any antibiotics (BNF chapter 5.1) prescribed in the last 12 months for any condition