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Volume 20, Number 5—May 2014

Dispatch

Factors Associated with Antimicrobial Drug Use in Medicaid Programs

Pengxiang LiComments to Author , Joshua P. Metlay, Steven C. Marcus, and Jalpa A. Doshi
Author affiliations: University of Pennsylvania, Philadelphia, Pennsylvania, USA

Main Article

Table 2

Factors associated with antimicrobial drug use among 194,874 adult Medicaid patients, 40 US states, 2007*

 Variable % Visits at which drugs were prescribed Odds ratio (95% CI)
Age, y
21–29 49.8 Referent
30–39 53.7 1.10 (1.05–1.16)
40–49 53.8 1.09 (0.99–1.20)
50–59 53.3 1.09 (0.96–1.23)
60–64 51.3 1.02 (0.89–1.16)
≥65
43.2
0.77 (0.63–0.94)
Sex
F 52.4 Referent
M
51.1
0.94 (0.90–0.99)
Race
White 56.9 Referent
Black 48.9 0.82 (0.74–0.91)
Hispanic 45.6 0.73 (0.64–0.82)
Other
45.0
0.75 (0.61–0.92)
Diagnosis at index visit
Cold or acute URI, ICD-9 codes 460 and 465 40.0 Referent
Acute bronchitis, ICD-9 code 466
69.0
3.32 (2.78–3.95)
RxHCC score†

0.94 (0.88–1.00)
Quarter of index visit date
Jul–Sep 52.8 Referent
Jan–Mar 52.3 1.04 (1.01–1.08)
Apr–Jun 52.1 1 (0.97–1.04)
Oct–Dec
51.1
0.98 (0.95–1.01)
Residence in low-education county‡
No 52.1 Referent
Yes
52.1
0.96 (0.85–1.09)
County–level annual per capita income (in $1,000)§ 1.00 (1.00–1.00)
Residence in urban area
No 55.8 Referent
Yes
50.2
0.91 (0.82–1.00)
Residence in state participating in CDC Get Smart campaign¶
No 57.7 Referent
Yes
50.7
0.74 (0.62–0.88)
No. primary care physicians/10,000 persons in county#
<2.2 56.8 Referent
2.2–3.4 56.2 0.96 (0.87–1.07)
3.5–4.7 55.4 0.91 (0.80–1.04)
4.8–6.5 51.4 0.84 (0.73–0.96)
>6.5 48.2 0.76 (0.66–0.88)

*Data are from the 2007 Medicaid Analytic Extract files linked with the Area Resource File. URI, upper respiratory tract infection; ICD-9, International Classification of Diseases, Ninth Revision; RxHCC, prescription drug Hierarchical Coexisting Condition; CDC, Centers for Disease Control and Prevention.
†Modified RxHCC score used here, wherein coefficients for age and sex are zeroed out in the score calculation because regression models separately control for these variables. Range in sample described here 0–5.3. A higher score indicates a higher medical comorbidity burden.
Odds ratio indicates the increased odds of antimicrobial drug use associated with per unit increase in the score.
‡The categories were based on quintile of county-level number of PCP physicians per 10,000 persons. Each category includes 644 counties.
§Defined as a county with ≥25% adults without a high school diploma.
¶In separate analysis, the county-level annual per capita income was coded as categorical variables according to the quintile of the measure across all counties in the Area Resource File. Similar to the continuous variables, the categorical variables were not significant.
#In our sample, 33 of 40 states participated in the CDC Get Smart campaign during 2002–2006.

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