Racial and Ethnic Differences in the Determinants of Antibiotic Use for Acute Gastroenteritis in the United States

BackgroundMost gastrointestinal infections do not require antimicrobial treatment, and the overall rate of use is low. However, differences in use across major American racial and ethnic groups is poorly understood. We estimated racial and ethnic disparities in antibiotic use for gastroenteritis and identified population-specific factors associated with use. MethodsWe analyzed the nationally representative 2018-2019 FoodNet Population Survey, limited to 1,950 individuals reporting gastroenteritis in the previous 7 days. Race and ethnicity were categorized as non-Hispanic Black, Hispanic, Other (Asian, Pacific Islander, American Indian and Alaska Native, and multiracial), and non-Hispanic White. Modified Poisson regression with survey weights estimated risk ratios for antibiotic use overall and within racial and ethnic groups. ResultsAntibiotic use was substantially higher among non-Hispanic Black (RR 4.6; 95% CI 4.01, 5.28), Hispanic (RR 2.2; 95% CI 1.00, 4.96), and Other (RR 3.8; 95%CI 2.27, 6.38) individuals, relative to non-Hispanic White respondents. Clinical factors were strongly associated with use in all racial and ethnic groups. However, socioeconomic associations qualitatively differed across groups; for example, higher income was associated with greater antibiotic use among Hispanic individuals but lower use among non-Hispanic Black individuals. Associations with social environment factors, such as Social Vulnerability Index and provider density, also varied by group. ConclusionsWe identified marked racial and ethnic disparities in antibiotic use, even after accounting for clinical and socioeconomic factors. Drivers of use differed by group, underscoring the need for tailored stewardship strategies and attention to the sociocultural factors influencing access to care and treatment decisions. SummaryAntibiotic use for gastroenteritis is low; however, antibiotic use is significantly greater among individuals identifying as Black, Hispanic, or other races and ethnicities, relative to White individuals. Factors associated with use vary by population, emphasizing needed tailoring of stewardship strategies.