Research Findings #23: Trends in Children's Antibiotic Use: 1996 to 2001
G. Edward Miller, Ph.D., and William A.
Carroll, B.S.
Abstract
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.
^top
Introduction
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.
^top
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.
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.
^top
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.
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.
^top
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.
^top
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
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.
2Among 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.
^top
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.
^top
References
Centers for Disease Control and
Prevention. Get smart: know when antibiotics work. Web site:
http://www.cdc.gov/getsmart/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 community-wide 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.
^top
Tables
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, 1996-2001.
|
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. |
^top
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 children reported to have otitis
media
in millions
|
|
Antibiotic use |
|
|
Population
characteristic |
Ambulatory
visita
|
|
With
ambulatory visit
|
Average prescriptions
given use
|
|
Overall |
|
|
|
|
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:
G. Edward Miller, Ph.D., and William A. Carroll, B.S. Trends
in Children's Antibiotic Use: 1996 to 2001. MEPS Research
Findings No. 23. AHRQ Pub. No. 05-0020. March 2005. Agency
for Healthcare Research and Quality, Rockville, MD. /data_files/publications/rf23/rf23.shtml
|
|
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