Abstract
Objectives
Chronic respiratory diseases (CRD) put patients at increased risk of respiratory infection and antimicrobial use, but surveillance results on community antimicrobial use are generally not adjusted for this risk factor. The objective of this study was to demonstrate the importance of accounting for CRD when interpreting indicators of community antimicrobial use in people over 65 years old, in Québec, Canada.
Methods
Retrospective cohort study of antimicrobial use according to CRD status in individuals over 65 years old covered by Québec’s public drug insurance plan between 2010 and 2015. Defined daily doses per 1000 person-days (DID) were computed per antimicrobial class and were further stratified according to chronic disease group, fiscal year, gender and age group.
Results
Antimicrobial use was 2.3 times higher in the CRD group (29.7 DID) compared with the other chronic disease group (13.1 DID) and 3.1 times higher than in the no chronic disease group (9.6 DID). The same gradient was reflected as well in use per antimicrobial class, per age group, per gender, and in time. Antimicrobial use increased throughout the study period and was higher in older age groups and in women.
Conclusions
Interpretation of results of antimicrobial use surveillance should consider the prevalence of CRD in populations. In order to identify opportunities for adapted interventions targeting inappropriate use, finer analyses are necessary.
Résumé
Objectifs
Les maladies respiratoires chroniques (MRC) accroissent le risque d’infection respiratoire des patients ainsi que leur utilisation d’antibiotiques, mais les résultats de surveillance de l’utilisation communautaire d’antibiotiques ne sont généralement pas ajustés pour ce facteur. L’objectif était de démontrer l’importance de prendre les MRC en compte lors de l’interprétation des indicateurs d’utilisation communautaire d’antibiotiques chez les personnes de plus de 65 ans au Québec, Canada.
Méthodologie
Étude de cohorte rétrospective portant sur l’utilisation d’antibiotiques selon la présence de MRC chez les individus de plus de 65 ans qui étaient couverts par le régime public d’assurance médicament du Québec, entre 2010 et 2015. Les doses journalières définies par 1000 individus-jours (DIJ) ont été calculées selon la classe d’antibiotiques, le groupe de maladie chronique, l’année financière, le genre et le groupe d’âge.
Résultats
L’utilisation d’antibiotiques était 2,3 fois plus élevée chez les individus ayant une MRC (29,7 DIJ) que chez ceux ayant une autre maladie chronique (13,1 DIJ) et 3,1 fois plus élevée que chez les individus n’ayant pas de maladie chronique (9,6 DIJ). Le même gradient était observable par classe d’antibiotiques, groupe d’âge, genre et année. L’utilisation d’antibiotiques a augmenté tout au long de la période à l’étude et elle était plus élevée chez les personnes plus âgées et chez les femmes.
Conclusions
La prévalence des MRC devrait être prise en compte lors de l’interprétation des résultats de surveillance de l’utilisation d’antibiotiques. Des analyses plus fines sont nécessaires afin d’identifier des opportunités d’interventions adaptées ciblant l’usage inapproprié des antibiotiques.
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Funding
This work was supported by the Ministère de la Santé et des services sociaux du Québec.
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Fortin, É., Jean, S., Sirois, C. et al. Chronic respiratory disease should be considered when interpreting indicators of community antimicrobial use in people over 65 years old. Can J Public Health 111, 443–447 (2020). https://doi.org/10.17269/s41997-019-00278-1
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DOI: https://doi.org/10.17269/s41997-019-00278-1