Resarch Findings
#23: Trends in Children's Antibiotic Use: 1996 to 2001
by G. Edward Miller, Ph.D.,
and William A. Carroll, B.S.
In the mid-1990s, concerns about
the overuse of antibiotics and the increasing prevalence of
antibiotic resistant bacterial infections in the United States
prompted public health and professional organizations to launch
national campaigns to promote the appropriate use of antibiotics.
This report uses nationally representative data from the Medical
Expenditure Panel Survey (MEPS) to examine antibiotic use
by U.S. children for the years 1996-2001. From 1996 to 2001,
the proportion of children who used an antibiotic during the
year declined from 39.0 percent to 29.0 percent and the average
number of antibiotic prescriptions for children declined from
0.9 to 0.5 per child. Use of antibiotics in the treatment
of otitis media also declined. The proportion of all children
for whom an antibiotic was prescribed to treat otitis media
fell from 14.4 percent in 1996 to 11.5 percent in 2001. Trends
in antibiotic use for subgroups of children defined by age,
race/ethnicity, sex, income, insurance status, health status,
and geography are also examined. From 1996-97 to 2000-01,
the percentage of children with antibiotic use and the average
number of prescriptions declined in each of the population
subgroups under consideration.
The estimates in this report are
based on the most recent data available at the time the report
was written. However, selected elements of MEPS data may be
revised on the basis of additional analyses, which could result
in slightly different estimates from those shown here. Please
check the MEPS Web site for the most current file releases.
Suggested citation
Miller
GE, Carroll WA. Trends in children's antibiotic use: 1996
to 2001. Rockville (MD): Agency for Healthcare Research
and Quality; 2005. MEPS
Research Findings No. 23. AHRQ Pub. No.05-0020.
Since their discovery in the 1940s, antibiotics
have transformed medical care and dramatically reduced illness
and death from infectious diseases (Centers for Disease Control
and Prevention, 2003). Increased use of these drugs throughout
the 1980s and early 1990s, however, led to concerns about the
overuse of antibiotics and the increasing prevalence of antibiotic
resistant bacterial infections. Children are a population of
particular concern because they have the highest rates of antibiotic
use and the highest rates of infection with antibiotic-resistant
pathogens of any age group (Perz, Craig, Coffey, et al., 2002).
Further, the majority of antibiotics prescribed for children
in the United States are for respiratory tract infections such
as otitis media, bronchitis, and pharyngitis (data from the
Medical Expenditure Panel Survey for 1996-2001, not shown),
and much of this prescribing is for viral conditions for which
antibiotics are not indicated (McCaig, Besser, and Hughes, 2002).
Since the mid-1990s concerns about
the overuse of antibiotics and the increasing prevalence of
antibiotic resistant bacterial
infections have prompted the Centers for Disease Control and
Prevention (CDC), the American Academy of Pediatrics (AAP),
and other public health and professional organizations to launch
national campaigns to promote the appropriate use of antibiotics.
Several recent studies (Finkelstein, Stille, Nordin, et al.,
2003; Mainous, Hueston, Davis, et al., 2003; McCaig, Besser,
and Hughes, 2002; Steinman, Gonzales, Linder, et al., 2003)
document sharp decreases, beginning in the mid-1990s, in overall
antibiotic use by children and in the use of antibiotics to
treat children’s respiratory tract infections such as
otitis media and bronchitis.
This report presents nationally
representative estimates from the Medical Expenditure Panel
Survey (MEPS) of antibiotic use
by children age 14 and under for the years 1996 through 2001.
The study examines trends in two measures of antibiotic use—the
percentage of children who used at least one antibiotic and
the average number of prescriptions—and the contributions
to these trends of changes in ambulatory visits and changes
in antibiotic use for children with a visit. In addition, it
looks at differences in antibiotic use across groups of children
defined by race/ethnicity, income, insurance status, and other
characteristics. Finally, it examines trends and differences
across groups in the use of antibiotics to treat otitis media. Throughout
this report only differences in estimates that are statistically
significant at the p < .05 level are discussed in the
text. In MEPS, information is obtained on drugs that are
purchased or otherwise acquired by members of the household.
There may be instances when a drug was prescribed but not
acquired or when a drug was acquired but not used. However,
for purposes of this report, the terms "prescribed," "purchased," and "used" are
interchangeable. The Technical Appendix provides substantial
detail on the sample design and definitions of measures
used in this report.
Findings
Overall
Trends in Antibiotic Use
Table 1 presents estimates of overall trends in antibiotic use. In 1996, 39.0
percent of the approximately 60 million children age 14 and under in the United
States had at least one prescription for an oral antibiotic. By 2001 the proportion
of children with antibiotic use had fallen to 29.0 percent. The average number
of antibiotic prescriptions also declined over this time period, from 0.9 per
child in 1996 to 0.5 per child in 2001. This decline resulted both because
of a lower percentage of children with any antibiotic use and because children
who used antibiotics had fewer prescriptions. Among children with use, the
average number of antibiotic prescriptions per child fell from 2.4 in 1996
to 1.9 in 2001.
From 1996 to 2001, the proportion of children who used an antibiotic during
the year declined from 39 percent to 29 percent.
Table 1 also shows that declines in antibiotic use were not steady during
the years studied. Instead, large reductions in the proportion with use
and in
the average
number of prescriptions occurred in the years 1996 through 1998. These initial
declines were followed by a flattening of the trends for both measures of antibiotic
use from 1998 through 2001.
Percentage
With Use
Table 2 presents estimates of the percentage
of children who used at least one antibiotic during the year by selected
population characteristics. Trends in antibiotic use are examined by
comparing average annual estimates for 1996-97 with estimates for 2000-01.
Pooling two years of data increases the precision of the estimates and
provides a sufficient sample to produce estimates for smaller subgroups
of children, such as uninsured children and children in fair or poor
health.
Before
a child receives an antibiotic, there must be either a visit
or a phone consultation with a physician or other practitioner
with the authority to prescribe drugs. The practitioner
then decides whether to prescribe an antibiotic for the
child. Both components of this process are potentially important
determinants of trends, and differences across groups, in
overall antibiotic use. Accordingly, Table 2 presents estimates
of the proportion of children with an ambulatory visit and
also presents estimates of conditional use-the proportion
of children with an ambulatory visit who were prescribed
an antibiotic.1 Since general checkups, well-child
visits, sick visits, and phone consultations are all included
in the measure of ambulatory visits, the percentage of children
with an ambulatory visit indicates contact with the health
care system rather than the intention to seek care for an
acute problem.
1In conducting these analyses,
no attempt was made to link specific visits and antibiotic purchases. Instead,
person-level variables were constructed that indicate whether a child ever
had an ambulatory visit during the year and whether a child ever was prescribed
an antibiotic during the year.
Overall Trends
The overall proportion of children using antibiotics during the year fell from
36.3 percent in 1996-97 to 28.8 percent in 2000-01. There was no statistically
significant change in visits, as approximately three quarters of children
had at least one ambulatory visit in both
1996-97 and 2000-01. There was, however, a large decrease in antibiotic
use among children with an ambulatory care visit, from 46.5 percent in
1996-97 to 37.7 percent in 2000-01.
There was no change in overall ambulatory visits from 1996 to 2001, but there
was a large decrease in antibiotic use among children with a visit.
Age
In both 1996-97 and 2000-01, the overall percentage of children using an antibiotic
declined with age across all three age categories. In 1996-97, nearly
half (46.0 percent) of children age 4 and under used an antibiotic, compared
to 37.6 percent of children ages 5-9 and 25.2 percent of children ages
10-14. Differences in visits and in conditional use both played a role
in the overall differences in use. The percent of children with a visit
and the percent of children with a visit who got an antibiotic both declined
with age.
From
1996-97 to 2000-01 the percentage of children with a visit
showed little or no change for any age group. Among children
with an ambulatory care visit, however, the proportion of
children who used an antibiotic showed large decreases in
all three age groups, resulting in a drop in the overall
rate of antibiotic use for all three age groups. By 2000-01,
the rate of antibiotic use had declined to 37.5 percent
for children age 4 and under, 29.6 percent for children
ages 5-9, and 19.8 percent for children ages 10-14.
Race/Ethnicity
In both 1996-97 and 2000-01, there were differences across racial/ethnic groups
in the overall percentage of children who were prescribed an antibiotic.
In 1996-97, the proportion of white/other children with antibiotic use
(41.5 percent) was higher than the proportion for Hispanic children (29.3
percent) and more than double the proportion for black children (20.6
percent). The difference in use between Hispanic and black children was
also statistically significant. Differences in overall antibiotic use
resulted from differences across racial/ethnic groups in both the percentage
of children with a visit and the rate of antibiotic use conditional on
a visit.
From
1996-97 to 2000-01, the percentage of children with a visit
did not change for any of the racial/ethnic groups, but
the percentage of children with a visit who were prescribed
an antibiotic declined sharply in all three groups. As a
result the overall rate of antibiotic use fell for all groups,
so that 33.2 percent of white/other children, 24.1 percent
of Hispanic children, and 15.6 percent of black children
used an antibiotic in 2000-01.
Sex
There were no statistically significant differences between girls and boys
in antibiotic use or ambulatory care visits in either 1996-97 or 2000-01.
Income, Health Insurance Status, and Perceived Health
Status
The results for income, health insurance status, and perceived health status
are similar to those observed for age and race/ethnicity. Differences in overall
rates of antibiotic use across groups of children defined by income, insurance
status, and health status persisted from 1996-97 to 2000-01. Over the same
time period, the percent with a visit showed little or no change and the conditional
rate of use showed a large decline in all groups of children.
In
2000-01 the overall rate of use increased steadily with
income, as 21.5 percent of poor/near poor, 25.0 percent
of low-income, 31.0 percent of middle-income, and 34.5 percent
of high-income children used an antibiotic during the year.
Overall
use varied by health insurance coverage. The proportion
using an antibiotic was 32.0 percent for children with any
private insurance, 24.0 percent for children with public
coverage only, and 17.8 percent for uninsured children.
Overall
use decreased steadily as health status improved. Children
in fair or poor health were the most likely (43.5 percent)
to use an antibiotic, compared to 32.1 percent of children
in good health and 27.7 percent of children in excellent
or very good health.
MSA and Census Region
In 1996-97 the percentage of children with antibiotic use was somewhat lower
for children who lived in metropolitan statistical areas (MSAs) than
for children living in non-MSA areas (35.6 percent vs. 39.4 percent).
The percent with use fell for both groups over the time period of our
study, and the difference in use persisted through 2000-01.
In
1996-97, Midwestern children had a higher rate of antibiotic
use (40.4 percent) than children from the other three Census
regions. By 2000-01, Midwestern children still had higher
rates of use than children from the West, but there was
no statistically significant difference in use between the
Midwest and the other two regions.
Average
Number of Prescriptions
Table 3 presents estimates of the average number of antibiotic prescriptions
for all children and the average number of prescriptions for children who had
at least one antibiotic by selected population characteristics. As
in Table 2, trends are examined by comparing average annual estimates for 1996-97
with estimates for 2000-01.
Overall Trends
The average annual number of antibiotic prescriptions purchased for children
age 14 and under in the United States declined by about one-third, from
48.9 million in 1996-97 to 32.9 million in 2000-01. Overall, the average
number of antibiotic prescriptions fell from 0.8 per child in 1996-97
to 0.5 per child in 2000-01. This decline resulted both because a lower
percentage of children had any antibiotic use (as documented in the previous
section) and because children who used antibiotics had fewer prescriptions.
Among children with use, average prescriptions fell from 2.3 in 1996-97
to 1.9 in 2000-01.
Age
The overall average number of prescriptions fell for children in each age group
from 1996-97 to 2000-01, and the number of prescriptions for children
with any antibiotic use fell for children age 4 and under and children
ages 5-9. Differences across age groups in the average number of prescriptions
persisted throughout this time period. In 2000-01, children age 4 and
under had the most prescriptions (0.8 per child), children ages 5-9 had
the second most (0.5 per child), and children ages 10-14 had the fewest
(0.3 per child). A similar pattern is seen among children who had at
least one antibiotic, with children age 4 and under using an average
of 2.1 prescriptions, children ages 5-9 using 1.8 prescriptions, and
children ages 10-14 using 1.6 prescriptions.
Race/Ethnicity
The overall average number of prescriptions declined for all three racial/ethnic
groups from 1996-97 to 2000-01, but the average number of prescriptions
among children who used any antibiotics showed a statistically significant
decline only for children in the white/other group. However, in 2000-01,
white/other children still had the highest average number of prescriptions:
0.6 per child, compared to 0.4 per child for Hispanics and 0.3 per child
for blacks.
Sex
There were no statistically significant differences
between girls and boys in the average number of prescriptions
purchased.
Income
The overall average number of prescriptions
declined for children in all income groups from 1996-97
to 2000-01, and the average number of prescriptions among
children with use declined for all except low-income children.
In 2000-01, high-income children had an average of 0.7 prescriptions
per child, middle-income children had 0.6 prescriptions
per child, and low-income and poor/near poor children had
an average of 0.4 prescriptions per child.
Health Insurance Status
The overall average number of prescriptions declined for
children in all insurance groups from 1996-97 to 2000-01, but the average prescriptions
among children with use declined only for children with any private insurance.
In 2000-01, the group with any private insurance had the highest overall average
number of prescriptions (0.6 per child). Children with only public insurance
had the next highest average (0.4 per child) and uninsured children used the
fewest prescriptions (0.3 per child).
Perceived Health Status
The overall average number of prescriptions declined for
children in all health status groups from 1996-97 to 2000-01, and the average
prescriptions among children with use declined for all children except those
in fair or poor health. The number of antibiotic prescriptions declined as
health status improved in both time periods. In 2000-01, children in fair or
poor health used the most prescriptions overall (1.4 per child), children in
good health used the second most (0.6 per child), and children in excellent
or very good health used the fewest (0.5 per child). Among children with use,
children in fair or poor health used an average of 3.1 prescriptions, compared
to 2.0 prescriptions for children in good health and 1.8 prescriptions for
children in excellent or very good health.
MSA and Census Region
The overall average number of prescriptions and the average
among children with use fell from 1996-97 to 2000-01 for children living in
MSAs and in non-MSA areas. In 2000-01, children who lived in non-MSA areas
used slightly more prescriptions per child (0.6 vs. 0.5).
The overall average number of prescriptions and the average
among children with use fell from 1996-97 to 2000-01 for children in all four
Census regions. In 2000-01, Southern and Midwestern children both used 0.6
prescriptions per child. Average prescriptions used were significantly higher
for Midwestern children than for Northeastern and Western children.
Trends and Differences in Treatment
of Otitis Media
Tables 4 and 5 present information on trends in the treatment
of otitis media. These condition-specific trends are of interest for
several reasons. First, otitis media, or ear infection, is the most common
reason that children receive an antibiotic. From 1996 to 2001, otitis
media accounted for about one-third of all antibiotic use by children
age 14 and under in the United States (data not shown). Second, the use
of antibiotics in the treatment of otitis media is often, but not always,
appropriate. Campaigns to encourage the appropriate use of antibiotics,
therefore, may be expected to have an effect on the treatment of this
condition. Finally, the percentage of children with an ambulatory visit
for otitis media provides information on differences across groups and
trends over time in the propensity to seek treatment for a highly prevalent
acute condition.
Overall Trends
From
1996 to 2001, the proportion of all children who took at least
one antibiotic to treat otitis media fell from 14.4 percent
to 11.5 percent.
Table 4 presents trends for all
children, regardless of whether they were reported to have
otitis media during the year. From 1996 to 2001, the proportion
of all children who took at least one antibiotic to treat
otitis media fell from 14.4 percent to 11.5 percent. Similar
to the trends for overall antibiotic use presented in Table
1, Table 4 shows that the decline in antibiotic use in the
treatment of otitis media was not steady during the years
of the study. Instead, a large reduction in the percentage
with use occurred from 1996 through 1999 and was then followed
by a flattening of the trend from 1999 through 2001.
In contrast to the results
for overall antibiotic use, however, reductions in the use of
antibiotics to treat otitis media were driven by declines in
ambulatory visits rather than declines in the rate of conditional
use. The percent of children with an ambulatory visit to seek
treatment for otitis media fell from 15.1 percent in 1996 to
12.7 percent in 2001. Similarly, the proportion of children
reported to have otitis media during the year fell from 21.1
percent in 1996 to 16.4 percent in 2001. Among children with
an ambulatory visit for otitis media, there was no statistically
significant change in the percentage prescribed an antibiotic
to treat their ear infection. The intensity of antibiotic use
did decline, however, as the average number of prescriptions
for children with use fell from 2.2 in 1996 to 1.8 in 2001.
Table 5 focuses on the population of children reported to have otitis media
and uses pooled data for the six years from 1996 through 2001. Pooling six
years of data increases the precision of the estimates and provides a sufficient
sample to produce estimates for smaller groups of children, such as the uninsured
or children in fair/poor health.
Overall, an average annual total of 10.4 million children were reported to
have otitis media during the time period of the study. Nearly four-fifths (78.1
percent) had an ambulatory visit to seek treatment for their otitis media and
70.0 percent were prescribed an antibiotic to treat this condition. Among children
with an ambulatory visit for otitis media, 78.6 percent got an antibiotic to
treat this condition.2
Because Table 5 uses pooled data for all six years, the focus is on differences
across groups rather than trends in use. These differences for groups defined
by age, race/ethnicity, and insurance status are highlighted in the following
text.
2 Among children reported to have otitis
media during the year, some (about 9 percent) were reported
to have used an antibiotic for this condition but were not reported
to have made an ambulatory visit specifically for otitis media.
These children are included among the 70 percent of children
who used an antibiotic for otitis media. Their antibiotic use
is not captured, however, in the calculation of rates of antibiotic
use among children with a visit for otitis media.
Age
The youngest children were the most likely to have their otitis
media treated with an antibiotic. Nearly three-quarters (73.2 percent) of children
age 4 and under used an antibiotic, compared to 66.4 percent of children ages
5-9 and 62.5 percent of children ages 10-14. There was no statistically significant
difference across age groups in the percentage of children with a visit for
otitis media, but the rate of antibiotic use conditional on a visit was higher
for children age 4 and under (81.9 percent) than for children ages 5-9 (75.5
percent) or children ages 10-14 (69.5 percent). Among children who used at
least one antibiotic, children age 4 and under also had more prescriptions
than the other age groups, an average of 2.1.
Race/Ethnicity
White/other children were more likely (71.7 percent)
than Hispanic children (64.9 percent) or black children (61.9
percent) to use an antibiotic to treat their otitis media. Differences
in visits and conditional rates of use both played a role in
this overall difference. White/other children were more likely
(79.5 percent) to have an ambulatory visit for otitis media
than Hispanic children (74.1 percent) or black children (70.7
percent). White/other children were also more likely (80.0 percent)
than Hispanic children (74.2 percent) or black children (70.7
percent) to be prescribed an antibiotic for otitis media if
they had an ambulatory visit for the condition.
Health Insurance Status
Children with any private insurance were more likely (72.2 percent)
than children with only public insurance (65.3 percent) or uninsured children
(57.1 percent) to use an antibiotic to treat their otitis media. Differences
in visits and conditional rates of use both played a role in the overall difference.
Children with any private insurance were more likely (79.7 percent) to have
an ambulatory visit than children with only public insurance (74.3 percent)
or uninsured children (69.0 percent). Children with any private insurance were
also more likely (80.2 percent) than children with only public insurance (74.3
percent) or uninsured children (68.7 percent) to use an antibiotic for otitis
media if they had an ambulatory visit for the condition. Among children who
used at least one antibiotic, children with any private insurance also had
more prescriptions than the other groups.
Summary and Conclusions
In the mid-1990s, concerns about the
overuse of antibiotics and the increasing prevalence of antibiotic resistant
bacterial infections prompted the Centers for Disease Control and Prevention,
the American Academy of Pediatrics, and other public health and professional
organizations to launch national campaigns to promote the appropriate use of
antibiotics. This report uses nationally representative data from MEPS to examine
antibiotic use by U.S. children in the years 1996-2001. Like previous studies
(Finkelstein, Stille, Nordin, et al., 2003; Mainous, Hueston, Davis, et al.,
2003; McCaig, Besser, and Hughes, 2002; Steinman, Gonzales, Linder, et al.,
2003), this study finds sharp declines in use beginning in the mid-1990s. From
1996 to 2001, the proportion of children age 14 and under who used an antibiotic
declined from 39.0 percent to 29.0 percent and the average number of antibiotic
prescriptions for children declined from 0.9 to 0.5 per child. Use of antibiotics
in the treatment of otitis media also declined. The proportion of all children
who took an antibiotic to treat otitis media fell from 14.4 percent in 1996
to 11.5 percent in 2001. Trends in antibiotic use for groups of children defined
by characteristics such as race/ethnicity, income, and insurance status show
reductions in use from 1996-97 to 2000-01 in all groups.
Reductions in antibiotic use were not steady over the period studied. Instead,
large reductions in use occurred from 1996 through 1998, followed by a flattening
of the trend from 1998 through 2001. Mainous and colleagues (2003) had similar
findings and suggested that the initial information released by the CDC in
1995, along with journal articles and news reports, appear to have been more
effective than the specific recommendations on judicious use issued by the
CDC and the AAP and disseminated in 1998. McCaig and colleagues (2002) also
noted that reduced antimicrobial use coincided with increased media attention
to the problem of antimicrobial resistance and with efforts by many organizations
to promote appropriate use.
The contributions of changes in ambulatory visits and changes in conditional
use to trends in the percentage of children with antibiotic use were also examined.
Since general checkups and well-child visits are included in the overall measure
of ambulatory visits, the percentage of children with any ambulatory visit
during the year indicates contact with the health care system rather than the
intention to seek care for an acute problem. Examination of overall use showed
no change from 1996-97 to 2000-01 in the proportion of children with an ambulatory
visit. Among children with a visit, however, the rate of antibiotic use decreased
significantly in almost every subgroup of children. With otitis media, by contrast,
sharp declines were found both in the percentage of children with an
ambulatory visit to seek treatment for this condition and in the percent of
children reported to have otitis media during the year. At the same time, the
conditional rate of antibiotic use in the treatment of otitis media did not
change.
McCaig and colleagues (2002) found similar results for the contributions of
visits and visit-based prescribing to trends in the use of antibiotics overall
and in the treatment of otitis media. Finkelstein and colleagues (2003) also
found a large reduction in the diagnosis of otitis media but no reduction in
antibiotic use if there was a diagnosis of otitis media. The observed reduction
in the proportion of children diagnosed with otitis media may reflect either
changes in the likelihood that parents sought care for this condition or changes
in clinicians' diagnostic thresholds. The results in this report are consistent
with either explanation.
In addition to examining overall trends, this report examines trends in antibiotic
use for subgroups of children defined by age, race/ethnicity, sex, income,
insurance status, health status, and geography. From 1996-97 to 2000-01, the
percentage of children with antibiotic use and the average number of prescriptions
declined in each of the population subgroups under consideration. This suggests
that the effects of campaigns to promote the appropriate use of antibiotics
were widespread. It also suggests that, in 1996-97, there was a perceived overuse
of antibiotics even among groups of children that had low levels of use relative
to their peers. One consequence of the widespread decline was that differences
across groups in overall antibiotic use persisted throughout the time period
of our study. Using pooled data, the researchers also found differences across
groups in the use of antibiotics to treat otitis media.
References
Centers for Disease Control and Prevention. Get smart: know when antibiotics
work. Web site: http://www.cdc.gov/drugresistance/community/. Accessed
Oct. 2004.
Cohen J. Design and
methods of the Medical Expenditure Panel Survey Household
Component.
Rockville (MD): Agency for Health Care Policy and Research;
1997. MEPS Methodology Report No. 1. AHRQ Pub. No. 97-0026.
Cohen S. Sample design of the 1996 Medical Expenditure Panel Survey Household
Component.
Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Methodology
Report No. 2. AHRQ Pub. No. 97-0027.
Cohen S. Sample design of the 1997 Medical Expenditure Panel Survey Household
Component.
Rockville (MD): Agency for Healthcare Research and Quality; 2000. MEPS Methodology
Report No. 11. AHRQ Pub. No. 01-0001.
Finkelstein JA, Stille C, Nordin J, et al. Reduction in antibiotic use among
US children, 1996-2000. Pediatrics 2003 Sep; 112(3 Pt 1): 620-7.
Mainous AG III, Hueston WJ, Davis MP, et al. Trends in antimicrobial prescribing
for bronchitis and upper
respiratory infections among adults and children. Am J Public Health 2003 Nov;
93(11):1910-4.
McCaig LF, Besser RE, Hughes JM. Trends in antimicrobial prescribing rates
for children and adolescents. JAMA 2002 Jun 19; 287(23):3096-102.
Moeller JF, Stagnitti MN, Horan E, et al. Outpatient prescription drugs: data
collection and editing in the
1996 Medical Expenditure Panel Survey (HC-010A). Rockville (MD): Agency for
Healthcare Research and
Quality; 2001. MEPS Methodology Report No. 12. AHRQ Pub. No. 01-0002.
Perz JF, Craig AS, Coffey CS, et al. Changes in antibiotic prescribing for
children after a communitywide
campaign. JAMA 2002; 287:3101-9.
Steinman MA, Gonzales R, Linder JA, et al. Changing use of antibiotics in community-based
outpatient
practice, 1991-1999. Ann Intern Med 2003 Apr; 138(7):525-33.
Table
1. Antibiotic use by children age 14 years
and under: United States, 1996 to 2001 |
Statistic |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
|
|
|
|
|
|
|
Population
sizea |
|
|
Number
in millions |
|
|
59.2 |
59.8 |
59.8 |
61.0 |
60.6 |
60.6 |
|
Percent
of children with any antibiotic use |
|
|
Percent |
|
|
39.0 |
33.7 |
30.6 |
28.9 |
28.6 |
29.0 |
|
Average
number of antibiotic prescriptions: |
|
|
Number |
|
|
All
children |
0.9 |
0.7 |
0.6 |
0.6 |
0.5 |
0.5 |
Children
with any antibiotic use |
2.4 |
2.1 |
1.9 |
2.0 |
1.9 |
1.9 |
a Age
is recorded at the end of the year.
Note: Does
not include topical antibiotics.
Source: Center
for Financing, Access, and Cost Trends, Agency for Healthcare
Research and Quality: Medical Expenditure Panel Survey,
Table
2. Antibiotic use by children age 14 years and
under: Use by selected population characteristics,
United States, 1996-97 and 2000-01 |
|
1996-97
annualized estimates of use |
|
2000-01 annualized
estimates of use |
|
|
|
Antibiotic
use |
|
|
|
Antibiotic
use |
Population
characteristic |
Total
population
in millions |
Ambulatory
visita |
Overall |
With
ambulatory
visit |
|
Total
population
in millions |
Ambulatory
visita |
Overall |
With
ambulatory
visit |
|
|
Percent |
|
|
Percent |
|
Total |
59.5 |
75.3 |
36.3 |
46.5 |
|
60.6 |
74.1 |
28.8 |
37.7 |
Age
in yearsb |
|
|
|
|
|
|
|
|
|
4
and under |
19.7 |
85.8 |
46.0 |
52.6 |
|
19.8 |
85.3 |
37.5 |
43.3 |
5-9 |
20.3 |
73.7 |
37.6 |
48.8 |
|
20.1 |
70.3 |
29.6 |
40.4 |
10-14 |
19.5 |
66.4 |
25.2 |
35.9 |
|
20.7 |
67.2 |
19.8 |
28.1 |
Race/ethnicity |
|
|
|
|
|
|
|
|
|
Hispanic |
9.2 |
67.2 |
29.3 |
41.5 |
|
10.6 |
68.3 |
24.1 |
34.0 |
Black |
9.3 |
63.9 |
20.6 |
30.5 |
|
9.5 |
63.2 |
15.6 |
23.2 |
White
and otherc |
41.0 |
79.7 |
41.5 |
50.3 |
|
40.5 |
78.2 |
33.2 |
41.3 |
Sex |
|
|
|
|
|
|
|
|
|
Male |
30.4 |
75.8 |
35.9 |
45.8 |
|
31.0 |
74.3 |
28.3 |
37.1 |
Female |
29.1 |
74.8 |
36.8 |
47.2 |
|
29.7 |
74.0 |
29.4 |
38.3 |
Incomed |
|
|
|
|
|
|
|
|
|
Poor
or near poor |
15.9 |
68.6 |
29.3 |
41.1 |
|
13.9 |
67.0 |
21.5 |
30.9 |
Low
income |
10.0 |
68.3 |
29.8 |
41.0 |
|
9.8 |
68.8 |
25.0 |
34.5 |
Middle
income |
20.0 |
77.6 |
39.8 |
49.4 |
|
19.9 |
74.7 |
31.0 |
40.3 |
High
income |
13.5 |
85.0 |
44.4 |
50.9 |
|
17.0 |
82.3 |
34.5 |
40.9 |
Health
insurance status |
Any
privatee |
40.1 |
79.0 |
40.4 |
49.3 |
|
40.9 |
77.1 |
32.0 |
40.2 |
Public
only |
13.3 |
71.9 |
29.9 |
40.2 |
|
14.6 |
72.8 |
24.0 |
32.1 |
Uninsured |
6.1 |
58.3 |
23.8 |
37.8 |
|
5.1 |
54.3 |
17.8 |
31.3 |
Perceived
health statusf |
Excellent
or very good |
47.4 |
74.5 |
34.6 |
44.5 |
|
49.6 |
73.1 |
27.7 |
36.7 |
Good |
9.4 |
77.5 |
42.2 |
53.1 |
|
9.4 |
76.5 |
32.1 |
40.7 |
Fair
or poor |
2.2 |
89.5 |
56.0 |
62.0 |
|
1.6 |
91.9 |
43.5 |
47.1 |
Metropolitan
statistical area (MSA)f |
MSA |
47.9 |
75.7 |
35.6 |
45.5 |
|
50.2 |
74.1 |
27.8 |
36.5 |
Non-MSA |
11.5 |
73.8 |
39.4 |
50.8 |
|
10.4 |
74.5 |
33.7 |
43.5 |
Census
region |
|
Northeast |
10.8 |
79.9 |
34.0 |
40.9 |
|
10.7 |
81.2 |
29.3 |
35.2 |
Midwest |
14.0 |
79.7 |
40.4 |
49.2 |
|
13.7 |
76.1 |
31.4 |
40.3 |
South |
20.4 |
72.9 |
36.9 |
48.8 |
|
21.2 |
71.8 |
28.7 |
38.2 |
West |
14.3 |
71.0 |
33.3 |
44.7 |
|
15.0 |
70.5 |
26.5 |
36.5 |
a Includes
visits to an office-based medical provider, emergency room,
or hospital outpatient department.
b Age
is recorded at the end of the year.
c Includes
all other racial/ethnic groups not shown separately.
d Poor
or near poor refers to persons living in families with income
of 125 percent of the Federal poverty line or
less;
low income, over 125 percent through 200 percent of the poverty
line; middle income, over 200 percent
through
400 percent of the poverty line; and high income, over 400 percent
of the poverty line.
e Includes
children with private and public coverage.
f Data
on this variable were not available for all sample persons.
Note: Does
not include topical antibiotics.
Source: Center
for Financing, Access, and Cost Trends, Agency for Healthcare
Research and Quality: Medical
Expenditure
Panel Survey, 1996-97 and 2000-01.
Table
3. Antibiotic use by children age 14 years and
under: Average number of antibiotic prescriptions
by selected population characteristics, United
States, 1996-97 and 2000-01 |
|
1996-97
annualized estimates of antibiotic use |
|
2000-2001
annualized estimates of antibiotic use |
Population
characteristic |
Total
prescriptions
in millions |
Average
number of prescriptions |
|
Total
prescriptions
in millions |
Average
number of prescriptions |
Overall |
With
use |
|
Overall |
With
use |
Total |
48.9 |
0.8 |
2.3 |
|
32.9 |
0.5 |
1.9 |
Age
in yearsa |
|
|
|
|
|
|
|
4
and under |
24.3 |
1.2 |
2.7 |
|
15.4 |
0.8 |
2.1 |
5-9 |
15.7 |
0.8 |
2.1 |
|
10.8 |
0.5 |
1.8 |
10-14 |
8.9 |
0.5 |
1.8 |
|
6.7 |
0.3 |
1.6 |
Race/ethnicity |
|
|
|
|
|
|
|
Hispanic |
5.5 |
0.6 |
2.1 |
|
4.8 |
0.4 |
1.9 |
Black |
3.5 |
0.4 |
1.8 |
|
2.5 |
0.3 |
1.7 |
White
and otherb |
39.8 |
1.0 |
2.3 |
|
25.7 |
0.6 |
1.9 |
Sex |
|
|
|
|
|
|
|
Male |
25.5 |
0.8 |
2.3 |
|
16.7 |
0.5 |
1.9 |
Female |
23.4 |
0.8 |
2.2 |
|
16.2 |
0.5 |
1.9 |
Incomec |
|
|
|
|
|
|
|
Poor
or near poor |
8.9 |
0.6 |
1.9 |
|
4.9 |
0.4 |
1.7 |
Low
income |
6.0 |
0.6 |
2.0 |
|
4.4 |
0.4 |
1.8 |
Middle
income |
19.6 |
1.0 |
2.5 |
|
12.1 |
0.6 |
2.0 |
High
income |
14.3 |
1.1 |
2.4 |
|
11.5 |
0.7 |
1.9 |
Health
insurance status |
|
|
|
|
|
|
Any
privated |
38.5 |
1.0 |
2.4 |
|
25.0 |
0.6 |
1.9 |
Public
only |
7.8 |
0.6 |
2.0 |
|
6.3 |
0.4 |
1.8 |
Uninsured |
2.6 |
0.4 |
1.8 |
|
1.6 |
0.3 |
1.8 |
Perceived
health statuse |
|
|
|
|
|
|
Excellent
or very good |
33.9 |
0.7 |
2.1 |
|
24.6 |
0.5 |
1.8 |
Good |
10.8 |
1.2 |
2.7 |
|
6.1 |
0.6 |
2.0 |
Fair
or poor |
4.2 |
1.9 |
3.4 |
|
2.2 |
1.4 |
3.1 |
Metropolitan
statistical area (MSA)e |
|
|
|
|
|
MSA |
38.7 |
0.8 |
2.3 |
|
26.2 |
0.5 |
1.9 |
Non-MSA |
10.2 |
0.9 |
2.3 |
|
6.7 |
0.6 |
1.9 |
Census
region |
|
|
|
|
|
|
|
Northeast |
8.3 |
0.8 |
2.3 |
|
5.7 |
0.5 |
1.8 |
Midwest |
12.8 |
0.9 |
2.3 |
|
8.6 |
0.6 |
2.0 |
South |
17.4 |
0.9 |
2.3 |
|
11.9 |
0.6 |
2.0 |
West |
10.4 |
0.7 |
2.2 |
|
6.7 |
0.4 |
1.7 |
a Age
is recorded at the end of the year.
b Includes
all other racial/ethnic groups not shown separately.
c Poor
or near poor refers to persons living in families with income
of 125 percent of the Federal poverty
line
or less; low income, over 125 percent through 200 percent
of the poverty line; middle income, over
200
percent through 400 percent of the poverty line; and high
income, over 400 percent of the poverty line.
d Includes
children with private and public coverage.
e Data
on this variable were not available for all sample persons.
Note:
Does not include topical antibiotics.
Source:
Center for Financing, Access, and Cost Trends, Agency for
Healthcare Research and Quality:
Medical
Expenditure Panel Survey, 1996-97 and 2000-01.
Table
4. Antibiotic use for otitis media by children
age 14 years and under: Summary statistics, United
States, 1996 to 2001 |
Statistic |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
|
|
|
|
|
|
|
|
Number
in millions |
Population
sizea |
59.2 |
59.8 |
59.8 |
61.0 |
60.6 |
60.6 |
Otitis
media (OM):b |
Percent |
Percent
reported to have OM |
21.1 |
19.1 |
17 |
15.3 |
15.4 |
16.4 |
Percent
with an ambulatory care visitc for OM |
15.1 |
13.7 |
14.4 |
12.9 |
12.5 |
12.7 |
Percent
prescribed an antibiotic for OM |
14.4 |
12.6 |
12.6 |
11.0 |
10.9 |
11.5 |
Percent
prescribed an antibiotic given an ambulatory |
|
|
|
|
|
|
care
visit for OM |
82.8 |
78.3 |
78.2 |
75.9 |
76.7 |
79.0 |
|
Number |
Average
number of antibiotic prescriptions for OM given use |
2.23 |
2.00 |
1.72 |
1.79 |
1.84 |
1.81 |
a Age
is recorded at the end of the year.
b Includes
conditions with an ICD-9 code of 381 or 382 (International Classification
of Diseases, 9th Revision).
c Includes
visits to an office-based medical provider, emergency room,
or hospital outpatient department.
Note:
Does not include topical antibiotics.
Source:
Center for Financing, Access, and Cost Trends, Agency for Healthcare
Research and Quality: Medical
Expenditure
Panel
Survey, 1996-2001.
Table
5. Antibiotic use for otitis media by children age
14 years and under: Use by selected population characteristics,
United States, 1996 to 2001 |
|
1996
to 2001 annualized estimates |
|
|
|
Antibiotic
use |
|
Population
characteristic |
Average
number of children reported to have otitis media in
millions |
Ambulatory
visita |
Overall |
With
ambulatory visit |
Average
prescriptions given use |
|
|
Percent |
Total |
10.4 |
78.1 |
70.0 |
78.6 |
1.9 |
|
|
|
|
|
|
Age
in yearsb |
|
|
|
|
|
4
and under |
6.3 |
78.0 |
73.2 |
81.9 |
2.1 |
5-9 |
2.9 |
78.4 |
66.4 |
75.5 |
1.6 |
10-14 |
1.3 |
77.8 |
62.5 |
69.5 |
1.4 |
Race/ethnicity |
|
|
|
|
|
Hispanic |
1.3 |
74.1 |
64.9 |
74.2 |
1.8 |
Black |
0.9 |
70.7 |
61.9 |
70.7 |
1.6 |
White
and otherc |
8.2 |
79.5 |
71.7 |
80.0 |
2.0 |
Sex |
|
|
|
|
|
Male |
5.4 |
78.8 |
69.1 |
77.3 |
2.0 |
Female |
5.0 |
77.3 |
71.0 |
79.9 |
1.8 |
Incomed |
|
|
|
|
|
Poor
or near poor |
2.0 |
75.5 |
64.5 |
73.6 |
1.6 |
Low
income |
1.5 |
75.8 |
67.2 |
76.0 |
1.8 |
Middle
income |
3.6 |
77.8 |
70.5 |
79.2 |
2.0 |
High
income |
3.3 |
81.0 |
74.1 |
81.9 |
2.0 |
Health
insurance status |
|
|
|
|
|
Any
privatee |
7.8 |
79.7 |
72.2 |
80.2 |
2.0 |
Public
only |
2.0 |
74.3 |
65.3 |
74.3 |
1.7 |
Uninsured |
0.6 |
69.0 |
57.1 |
68.7 |
1.6 |
Perceived
health statusf |
|
|
|
|
|
Excellent
or very good |
8.0 |
77.7 |
70.3 |
79.2 |
1.8 |
Good |
1.9 |
79.8 |
68.5 |
75.9 |
2.1 |
Fair
or poor |
0.5 |
81.4 |
73.9 |
79.3 |
2.7 |
Metropolitan
statistical area (MSA) |
MSA |
8.4 |
77.3 |
69.8 |
78.9 |
1.9 |
Non-MSA |
2.1 |
81.1 |
70.6 |
77.2 |
2.0 |
Census
region |
|
|
|
|
|
Northeast |
2.0 |
77.6 |
70.4 |
78.4 |
1.9 |
Midwest |
2.6 |
80.1 |
74.6 |
82.5 |
2.0 |
South |
3.4 |
77.4 |
67.7 |
76.9 |
2.0 |
West |
2.4 |
77.3 |
68.1 |
76.7 |
1.8 |
a Includes
visits to an office-based medical provider, emergency room,
or hospital outpatient department.
b Age
is recorded at the end of the year.
c Includes
all other racial/ethnic groups not shown separately.
d Poor
or near poor refers to persons living in families with income
of 125 percent of the Federal poverty line or less;
low
income, over 125 percent through 200 percent of the poverty
line; middle income, over 200 percent through 400
percent
of the poverty line; and high income, over 400 percent of
the poverty line.
e Includes
children with private and public coverage.
f Data
on this variable were not available for all sample persons.
Note:
Does not include topical antibiotics.
Source:
Center for Financing, Access, and Cost Trends, Agency for
Healthcare Research and Quality: Medical
Expenditure
Panel Survey, 1996-2001.
Technical
Appendix
The data used in this report were
obtained from interviews conducted as part of the Household
Component of the Medical Expenditure Panel Survey (MEPS) for
1996-2001. MEPS is an ongoing, annual survey of the civilian
noninstitutionalized population. MEPS collects detailed information
on health care use and expenditures (including sources of
payment); health insurance; and health status, access, and
quality. It also collects detailed demographic and economic
information on the persons and households surveyed. More information
about MEPS can be found at http://www.meps.ahrq.gov. For a
detailed description of the survey and its methodology, also
see J. Cohen (1997) and S. Cohen (1997, 2000).
Survey Design
Each year, the MEPS sample is drawn from
households that completed the prior year's National Health
Interview Survey (NHIS). Households selected for participation
in the 1996 MEPS completed interviews in the 1995 NHIS,
the 1997 MEPS sample was drawn from the 1996 NHIS, and so
on. Because NHIS is used as a sampling frame, the MEPS design
is not only nationally representative of the civilian noninstitutionalized
population but also includes an oversampling of Hispanics
and blacks.
MEPS collects data in an overlapping
panel design. Each household completes five interviews
("rounds" of data collection) over a period of 21/2 years,
providing data for two full calendar years of estimates. Data
from Rounds 1, 2, and 3 provide information for the first
year of estimation, and data from Rounds 3, 4, and 5 provide
data for the second year of estimates. For example, estimates
for 2001 are derived by combining Rounds 3, 4, and 5 of the
2000 panel and Rounds 1, 2, and 3 of the 2001 panel. An exception
is 1996, when the MEPS longitudinal data collection was initiated.
For that year, a single panel's data were used for estimation.
In MEPS, a single respondent provides most of the information
to an interviewer using computer-assisted personal interviewing
(CAPI). In addition to the CAPI interview, beginning in 2000,
limited data have been collected using a self-administered
questionnaire (SAQ).
Definitions
Antibiotics.
The definition of antibiotics includes all major classes
of oral antibiotics but excludes topical antibiotics.
Ambulatory care visits.
This category includes visits to medical providers seen in
office-based settings or clinics, hospital outpatient departments,
and emergency rooms. It also includes phone contacts with
providers in office-based settings.
Age. In this report, age
is the last available age for the sampled person.
Race/ethnicity. Classification
by race and ethnicity was based on information provided by
the household respondent for each household member. The respondent
was asked if each person's race was best described as black,
white, Asian or Pacific Islander, American Indian, or Alaska
Native. The respondent was also asked if each person's main
national origin or
ancestry was Puerto Rican, Cuban, Mexican, Mexicano, Mexican American, or Chicano;
other Latin American; or other Spanish. Persons claiming a main national origin
or ancestry in one of these Hispanic groups, regardless of racial background,
were classified as Hispanic. Since the Hispanic grouping can include persons
of any race, the race categories of black and white/other exclude Hispanics.
Income. Each year, persons
were classified according to their family's income in terms
of poverty status. In this report, poverty status is the ratio
of the family's income to the Federal poverty thresholds,
which control for the size of the family and the age of the
head of the family. In this report, the following classification
of poverty status was used.
- Poor or near poor: Persons
in families with income of 125 percent of the poverty line
or less, including those who reported negative income.
- Low income: Persons in
families with income from over 125 percent through 200 percent
of the poverty line.
- Middle income: Persons
in families with income from over 200 percent through 400
percent of the poverty line.
- High income: Persons
in families with income over 400 percent of the poverty
line.
In MEPS, personal income from
all household members is summed to create family income. Potential
income sources asked about in the survey interview include
annual earnings from wages, salaries, bonuses, tips, and commissions;
business and farm gains and losses; unemployment and Workers' Compensation
payments; interest and dividends; alimony, child support,
and other private cash transfers; private pensions; individual
retirement account (IRA) withdrawals; Social Security and
Department of Veterans Affairs payments; Supplemental Security
Income and cash welfare payments from public assistance, TANF
(Temporary Assistance for Needy Families; formerly known as
Aid to Families with Dependent Children, or AFDC); gains or
losses from estates, trusts, partnerships, S corporations,
rent, and royalties; and a small amount of "other" income.
Health insurance status. Respondents were asked about
health insurance coverage for themselves and all household
members at each round of interviewing. The insurance variables
reflect coverage for hospital and physician services. Persons
categorized as having insurance coverage may or may not
have coverage for prescription drugs.
- Any private insurance.
This group includes those who, at any time in the survey
year, had individual or group plan coverage for medical
or related expenses, including prepaid health plans such
as health maintenance organizations but excluding extra
cash coverage plans, medical benefits linked only to specific
diseases (dread disease plans), and casualty benefit plans
(such as automobile insurance).
- Public insurance only.
This group includes persons who were never covered by private
insurance during the year but who were covered at any time
by Medicare, TRICARE (which covers retired members of the
uniformed services and the spouses and children of active-duty
military), Medicaid, and other State and local medical assistance
programs.
- Uninsured. This group
comprises all persons with neither public nor private insurance
coverage throughout the calendar year.
Perceived health status.
During each round of interviewing, the household respondent
was asked to rate the health of each person in the family
according to the following categories: excellent, very good,
good, fair, or poor. For this report, the response categories "excellent" and "very
good" were collapsed, as were "fair" and "poor." Also,
for this report, each person's health status was determined
using the worst reported health status during the year.
MSA. Individuals were identified
as residing either inside or outside a metropolitan statistical
area (MSA) as designated by the U.S. Office of Management
and Budget, which applied 1990 standards using population
counts from the 1990 U.S. census. An MSA is a large population
nucleus combined with adjacent communities that have a high
degree of economic and social integration with the nucleus.
Each MSA has one or more central counties containing the area's
main population concentration. In New England, metropolitan
areas consist of cities and towns rather than whole counties.
Census region.
Each MEPS sampled person was classified as living in one
of the following four regions as defined by the U.S. Census
Bureau.
- Northeast: Maine, New Hampshire,
Vermont, Massachusetts, Rhode Island, Connecticut, New York,
New Jersey, and Pennsylvania.
- Midwest: Ohio, Indiana, Illinois,
Michigan, Wisconsin, Minnesota, Iowa, Missouri, South
Dakota, North Dakota, Nebraska, and Kansas.
- South: Delaware, Maryland, District
of Columbia, Virginia, West Virginia, North Carolina, South
Carolina, Georgia, Florida, Kentucky, Tennessee, Alabama,
Mississippi, Arkansas, Louisiana, Oklahoma, and Texas.
- West: Montana, Idaho, Wyoming,
Colorado, New Mexico, Arizona, Utah, Nevada, Washington,
Oregon, California, Alaska, and Hawaii.
Sample
Design and Accuracy of Estimates
The statistics presented in this report are affected by both sampling error and
sources of nonsampling error, which include nonresponse bias, respondent reporting
errors, interviewer effects, and data processing misspecifications. The MEPS
person-level estimation weights include nonresponse adjustments and poststratification
adjustments to population estimates derived from the Current Population Survey
based on cross-classifications by region, MSA, age, race/ethnicity, and sex.
The overall MEPS response rate reflects response to both the MEPS and NHIS interviews.
The sample size and annual response rates
are:
Calendar
year |
|
Sample
size |
|
Pooled
annual response rate |
1996 |
|
21,571 |
|
70.2 |
1997 |
|
32,636 |
|
66.4 |
1998 |
|
22,953 |
|
67.9 |
1999 |
|
23,565 |
|
64.3 |
2000 |
|
23,839 |
|
65.3 |
2001 |
|
32,122 |
|
66.3 |
Rounding
Because of rounding and some missing data, some of the subpopulation estimates
presented in the tables will
not sum exactly to the overall population total. Standard errors are presented
in Tables A-E.
Standard Error
Tables
Table
A. Standard errors for antibiotic use by children age
14 years and under: Summary statistics, United States,
1996 to 2001 |
Corresponds
to Table 1 |
|
Statistic |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
|
Standard
error |
Population
sizea |
1.72 |
1.39 |
1.80 |
2.00 |
2.66 |
1.58 |
Percent
of children with any antibiotic use |
0.93 |
0.78 |
0.84 |
0.95 |
0.85 |
0.77 |
Average
number of antibiotic prescriptions: |
All
children |
0.04 |
0.02 |
0.02 |
0.03 |
0.02 |
0.02 |
Children
with any antibiotic use |
0.07 |
0.05 |
0.05 |
0.06 |
0.05 |
0.04 |
|
a Age
is recorded at the end of the year. |
Note: Does
not include topical antibiotics. |
Source: Center
for Financing, Access, and Cost Trends, Agency for
Healthcare Research and Quality: Medical Expenditure
Panel Survey, 1996-2001. |
Table
B. Standard errors for antibiotic use by children age
14 years and under: Use by selected population characteristics,
United States, 1996-97 and 2000-01 |
|
Corresponds
to Table 2 |
|
|
|
1996-97
annualized estimates of use |
|
2000-01
annualized estimates of use |
|
|
|
Antibiotic
use |
|
|
Antibiotic
use |
Population
characteristic |
Total
population in millions |
Ambulatory
visita |
Overall |
With ambulatory
visit |
Total
population in millions |
Ambulatory
visita |
Overall |
With ambulatory
visit |
|
Standard
error |
Total |
1.58 |
0.58 |
0.61 |
0.71 |
|
1.97 |
0.62 |
0.57 |
0.74 |
Age
in yearsb |
|
|
|
|
|
|
|
|
4
and under |
0.62 |
0.73 |
1.02 |
1.10 |
0.78 |
0.76 |
1.00 |
1.16 |
5-9 |
0.65 |
0.83 |
0.99 |
1.16 |
0.67 |
0.91 |
0.95 |
1.28 |
10-14 |
0.60 |
1.02 |
0.87 |
1.13 |
0.74 |
0.89 |
0.69 |
0.94 |
Race/ethnicity |
Hispanic |
0.41 |
1.14 |
1.20 |
1.48 |
|
0.52 |
1.21 |
1.04 |
1.36 |
Black |
0.52 |
1.39 |
1.09 |
1.60 |
0.58 |
1.43 |
0.96 |
1.37 |
White
and otherc |
1.27 |
0.66 |
0.80 |
0.90 |
1.58 |
0.76 |
0.74 |
0.89 |
Sex |
Male |
0.86 |
0.73 |
0.79 |
0.95 |
|
1.02 |
0.80 |
0.74 |
0.96 |
Female |
0.83 |
0.74 |
0.85 |
0.98 |
|
1.03 |
0.76 |
0.72 |
0.91 |
Incomed |
Poor
or near poor |
0.64 |
1.04 |
1.08 |
1.36 |
|
0.62 |
1.28 |
1.07 |
1.41 |
Low
income |
0.47 |
1.25 |
1.19 |
1.51 |
0.43 |
1.50 |
1.19 |
1.48 |
Middle
income |
0.69 |
0.90 |
1.06 |
1.20 |
0.84 |
0.95 |
1.01 |
1.19 |
High
income |
0.57 |
0.92 |
1.33 |
1.45 |
0.78 |
0.97 |
1.24 |
1.40 |
Health
insurance status |
Any
privatee |
1.20 |
0.70 |
0.77 |
0.88 |
|
1.49 |
0.69 |
0.74 |
0.85 |
Public
only |
0.55 |
1.06 |
1.12 |
1.35 |
0.62 |
1.16 |
1.08 |
1.37 |
Uninsured |
0.30 |
1.73 |
1.49 |
2.15 |
0.31 |
1.87 |
1.34 |
2.18 |
Perceived
health statusf |
Excellent
or very good |
1.29 |
0.65 |
0.67 |
0.79 |
|
1.63 |
0.69 |
0.61 |
0.78 |
Good |
0.38 |
1.23 |
1.41 |
1.58 |
0.45 |
1.29 |
1.29 |
1.56 |
Fair
or poor |
0.12 |
1.62 |
2.65 |
2.71 |
0.13 |
1.44 |
3.26 |
3.48 |
Metropolitan
statistical area (MSA)f |
MSA |
1.42 |
0.65 |
0.70 |
0.82 |
|
1.84 |
0.70 |
0.64 |
0.84 |
Non-MSA |
0.70 |
1.31 |
1.38 |
1.59 |
0.61 |
1.05 |
1.20 |
1.51 |
Census
region |
Northeast |
0.58 |
1.31 |
1.40 |
1.62 |
|
0.54 |
1.50 |
1.37 |
1.58 |
Midwest |
0.76 |
0.89 |
1.38 |
1.62 |
0.94 |
1.20 |
1.01 |
1.21 |
South |
1.08 |
1.04 |
1.08 |
1.21 |
1.18 |
1.00 |
1.05 |
1.27 |
West |
0.65 |
1.23 |
1.10 |
1.41 |
1.10 |
1.19 |
1.17 |
1.79 |
|
a Includes
visits to an office-based medical provider, emergency
room, or hospital outpatient department. |
b Age
is recorded at the end of the year. |
c Includes
all other racial/ethnic groups not shown separately. |
d Poor
or near poor refers to persons living in families
with income of 125 percent of the Federal poverty
line or less; low income, over 125 percent through
200 percent of the poverty line; middle income, over
200 percent through 400 percent of the poverty line;
and high income, over 400 percent of the poverty line. |
e Includes
children with private and public coverage. |
f Data
on this variable were not available for all sample
persons. |
Note: Does
not include topical antibiotics. |
Source: Center
for Financing, Access, and Cost Trends, Agency for
Healthcare Research and Quality: Medical Expenditure
Panel Survey, 1996-97 and 2000-01. |
Table
C. Standard errors for antibiotic use by children age
14 years and under: Average number of antibiotic prescriptions
by selected population characteristics, United States,
1996-97 and 2000-01. |
Corresponds
to Table 3 |
|
|
|
|
|
|
|
|
|
1996-97
annualized estimates |
|
2000-01
annualized estimates |
|
of
antibiotic use |
|
of
antibiotic use |
|
Total |
Average
number |
|
Total |
Average
number |
Population |
prescriptions |
of
prescriptions |
|
prescriptions |
of
prescriptions |
characteristic |
in
millions |
Overall |
With
use |
|
in
millions |
Overall |
With
use |
|
|
|
|
|
|
|
|
|
Standard
error |
Total |
1.99 |
0.02 |
0.04 |
|
1.48 |
0.02 |
0.03 |
Age
in yearsa |
|
|
|
|
|
|
|
4
and under |
1.27 |
0.05 |
0.09 |
|
0.91 |
0.03 |
0.05 |
5-9 |
0.80 |
0.03 |
0.06 |
|
0.63 |
0.02 |
0.05 |
10-14 |
0.61 |
0.03 |
0.08 |
|
0.37 |
0.01 |
0.05 |
Race/ethnicity |
Hispanic |
0.41 |
0.03 |
0.07 |
|
0.42 |
0.03 |
0.09 |
Black |
0.39 |
0.03 |
0.12 |
|
0.23 |
0.02 |
0.08 |
White
and otherb |
1.83 |
0.03 |
0.05 |
|
1.34 |
0.02 |
0.04 |
Sex |
Male |
1.25 |
0.03 |
0.06 |
|
0.90 |
0.02 |
0.05 |
Female |
1.12 |
0.03 |
0.06 |
|
0.74 |
0.02 |
0.04 |
Incomec |
Poor
or near poor |
0.56 |
0.03 |
0.06 |
|
0.39 |
0.02 |
0.06 |
Low
income |
0.47 |
0.04 |
0.10 |
|
0.37 |
0.03 |
0.09 |
Middle
income |
1.21 |
0.04 |
0.08 |
|
0.79 |
0.03 |
0.06 |
High
income |
0.98 |
0.06 |
0.10 |
|
0.76 |
0.03 |
0.05 |
Health
insurance status |
Any
privated |
1.88 |
0.03 |
0.06 |
|
1.23 |
0.02 |
0.04 |
Public
only |
0.50 |
0.03 |
0.06 |
|
0.50 |
0.03 |
0.07 |
Uninsured |
0.27 |
0.04 |
0.11 |
|
0.16 |
0.03 |
0.10 |
Perceived
health statuse |
Excellent
or very good |
1.45 |
0.02 |
0.05 |
|
1.13 |
0.02 |
0.03 |
Good |
0.74 |
0.06 |
0.12 |
|
0.44 |
0.04 |
0.08 |
Fair
or poor |
0.43 |
0.16 |
0.22 |
|
0.31 |
0.16 |
0.27 |
Metropolitan
statistical area (MSA)e |
MSA |
1.81 |
0.03 |
0.05 |
|
1.33 |
0.02 |
0.04 |
Non-MSA |
0.80 |
0.05 |
0.09 |
|
0.59 |
0.03 |
0.06 |
Census
region |
Northeast |
0.81 |
0.05 |
0.11 |
|
0.43 |
0.03 |
0.08 |
Midwest |
1.01 |
0.05 |
0.07 |
|
0.69 |
0.03 |
0.05 |
South |
1.28 |
0.04 |
0.09 |
|
0.87 |
0.03 |
0.07 |
West |
0.74 |
0.04 |
0.09 |
|
0.78 |
0.03 |
0.05 |
|
|
|
|
|
|
|
|
a Age
is recorded at the end of the year. |
b Includes
all other racial/ethnic groups not shown separately. |
c Poor
or near poor refers to persons living in families
with income of 125 percent of the Federal poverty
line or less; low income, over 125 percent through
200 percent of the poverty line; middle income, over
200 percent through 400 percent of the poverty line;
and high income, over 400 percent of the poverty line. |
d Includes
children with private and public coverage. |
e Data
on this variable were not available for all sample
persons. |
Note: Does
not include topical antibiotics. |
Source: Center
for Financing, Access, and Cost Trends, Agency for
Healthcare Research and Quality: Medical Expenditure
Panel Survey, 1996-97 and 2000-01. |
Table
D. Standard errors for antibiotic use for otitis media
by children age 14 years and under: Summary statistics,
United States, 1996 to 2001 |
Corresponds
to Table 4 |
|
Statistic |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
|
Standard
error |
Population
size)a |
1.72 |
1.39 |
1.80 |
2.00 |
2.66 |
1.58 |
Otitis
media (OM):b |
Percent
reported to have OM |
0.76 |
0.65 |
0.73 |
0.75 |
0.62 |
0.60 |
Percent
with an ambulatory care visitc for OM |
0.63 |
0.54 |
0.69 |
0.72 |
0.58 |
0.52 |
Percent
prescribed an antibiotic for OM |
0.63 |
0.51 |
0.60 |
0.64 |
0.56 |
0.50 |
Percent
prescribed an antibiotic given an ambulatory |
|
|
|
|
|
|
care
visit for OM |
1.88 |
1.56 |
1.76 |
2.33 |
1.97 |
1.63 |
Average
number of antibiotic prescriptions for OM given
use |
0.10 |
0.08 |
0.06 |
0.07 |
0.08 |
0.07 |
|
a Age
is recorded at the end of the year. |
b Includes
conditions with an ICD-9 code of 381 or 382 (International
Classification of Diseases, 9th Revision). |
c Includes
visits to an office-based medical provider, emergency
room, or hospital outpatient department. |
Note: Does
not include topical antibiotics. |
Source: Center
for Financing, Access, and Cost Trends, Agency for
Healthcare Research and Quality: Medical Expenditure
Panel Survey, 1996-97 and 2000-01. |
Table
E. Standard errors for antibiotic use for otitis media
by children age 14 years and under: Use by selected population
characteristics, United States, 1996 to 2001 |
Corresponds
to Table 5 |
|
|
1996
to 2001 annualized estimates |
|
Average
number of |
|
Antibiotic
use |
|
Population |
children
reported to have |
Ambulatory |
|
With |
Average
prescriptions |
characteristic |
otitis
media in millions |
visita |
Overall |
ambulatory
visit |
given
use |
|
|
Standard
error |
Total |
0.35 |
0.65 |
0.76 |
0.76 |
0.03 |
Age
in yearsb |
4
and under |
0.23 |
0.91 |
0.91 |
0.89 |
0.05 |
5-9 |
0.12 |
1.2 |
1.42 |
1.48 |
0.04 |
10-14 |
0.07 |
1.68 |
2.39 |
2.58 |
0.05 |
Race/ethnicity |
Hispanic |
0.07 |
1.46 |
1.46 |
1.47 |
0.08 |
Black |
0.06 |
2.34 |
2.41 |
2.57 |
0.07 |
White
and otherc |
0.31 |
0.73 |
0.88 |
0.88 |
0.04 |
Sex |
Male |
0.21 |
0.92 |
1 |
1.03 |
0.05 |
Female |
0.19 |
0.91 |
1.06 |
1.07 |
0.04 |
Incomed |
Poor
or near poor |
0.1 |
1.44 |
1.56 |
1.71 |
0.04 |
Low
income |
0.08 |
1.69 |
1.95 |
2.01 |
0.07 |
Middle
income |
0.16 |
1.1 |
1.31 |
1.31 |
0.06 |
High
income |
0.14 |
1.33 |
1.36 |
1.36 |
0.07 |
Health
insurance status |
Any
privatee |
0.28 |
0.75 |
0.87 |
0.86 |
0.04 |
Public
only |
0.1 |
1.41 |
1.6 |
1.72 |
0.05 |
Uninsured |
0.05 |
2.89 |
2.96 |
3.38 |
0.1 |
Perceived
health statusf |
Excellent
or very good |
0.28 |
0.75 |
0.86 |
0.84 |
0.03 |
Good |
0.09 |
1.44 |
1.64 |
1.71 |
0.09 |
Fair
or poor |
0.04 |
2.4 |
3.15 |
3.07 |
0.18 |
Metropolitan
statistical area (MSA)f |
MSA |
0.29 |
0.76 |
0.85 |
0.84 |
0.04 |
Non-MSA |
0.13 |
1.4 |
1.61 |
1.71 |
0.07 |
Census
region |
Northeast |
0.12 |
1.59 |
1.83 |
1.9 |
0.08 |
Midwest |
0.16 |
1.35 |
1.51 |
1.34 |
0.06 |
South |
0.18 |
1.22 |
1.32 |
1.34 |
0.06 |
West |
0.16 |
1.38 |
1.42 |
1.51 |
0.06 |
|
|
|
|
|
|
a Includes
visits to an office-based medical provider, emergency
room, or hospital outpatient department. |
b Age
is recorded at the end of the year. |
c Includes
all other racial/ethnic groups not shown separately. |
d Poor
or near poor refers to persons living in families
with income of 125 percent of the Federal poverty
line or less; low income, over 125 percent through
200 percent of the poverty line; middle income, over
200 percent through 400 percent of the poverty line;
and high income, over 400 percent of the poverty line. |
e Includes
children with private and public coverage. |
f Data
on this variable were not available for all sample
persons. |
Note: Does
not include topical antibiotics. |
Source: Center
for Financing, Access, and Cost Trends, Agency for
Healthcare Research and Quality: Medical Expenditure
Panel Survey, 1996-97 and 2000-01. |
^top
Suggested
Citation:
Nancy A. Krauss, M.S., and Barbara M. Altman, Ph.D. Characteristics
of Nursing Home Residents--1996. MEPS Research Findings
No. 5. AHRQ Pub. No. 99-0060. December 2004. Agency
for Healthcare Research and Quality, Rockville,
MD.
http://www.meps.ahrq.gov/data_files/rf5.shtml
|
|