ArticleGlobalization and health2023
Socio-economic, governance and health indicators shaping antimicrobial resistance: an ecological analysis of 30 european countries.
Article in Globalization and health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers.
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29 citing papers in PubMed, 56 citations in OpenAlex.
- Agricultural Pesticide Exposure and Antimicrobial Resistance inMicroorganisms · 2026Article
- Antimicrobial Resistance in Six Priority Bacteria in Italy: Trends and Regional Variation, 2015-2024.Antibiotics (Basel, Switzerland) · 2026Article
- Global Trends in Antimicrobial Resistance-Related Mortality fromTropical medicine and infectious disease · 2026Article
- Beyond borders: Europe's leadership role in tackling transboundary antimicrobial resistance.JAC-antimicrobial resistance · 2026Review
- Strengthening antimicrobial resistance governance in Europe: a coordinated one health approach.The Lancet regional health. Europe · 2026Review
- Country governance of antimicrobial resistance (AMR) surveillance: observations on global progress and aid programme effectiveness using data from the Tracking AMR Country Self-Assessment Survey (TrACSS).Globalization and health · 2026Article
- Prioritization of antimicrobial resistance surveillance of gram-negative pathogens - a stacked modelling approach.Wellcome open research · 2026Article
- Area-level socioeconomic status inequalities shape patterns of antimicrobial resistance in China, 2014-2023: a Bayesian spatiotemporal modelling analysis.The Lancet regional health. Western Pacific · 2025Article
- Article
- Spatial panel data analysis of antimicrobial resistance in Escherichia coli in China.Scientific reports · 2025Article
- Invisible Engines of Resistance: How Global Inequities Drive Antimicrobial Failure.Antibiotics (Basel, Switzerland) · 2025Review
- Construction of Development Scores to Analyze Inequalities in Childhood Immunization Coverage: A Global Analysis from 2000 to 2021.International journal of environmental research and public health · 2025Article
- Panel data analysis of the effect of ambient temperature on antimicrobial resistance in China.Scientific reports · 2025Article
- Factors associated with clinical antimicrobial resistance in China: a nationwide analysis.Infectious diseases of poverty · 2025Article
- Enhancing antimicrobial resistance surveillance and research: a systematic scoping review on the possibilities, yield and methods of data linkage studies.Antimicrobial resistance and infection control · 2025Article
- NewPHAGE (New Rochelle, N.Y.) · 2025Article
- Longitudinal monitoring of sewershed resistomes in socioeconomically diverse urban neighborhoods.Communications medicine · 2025Article
- The challenge of antimicrobial resistance (AMR): current status and future prospects.Naunyn-Schmiedeberg's archives of pharmacology · 2024Review
- Optimizing Antibiotic Use: Addressing Resistance Through Effective Strategies and Health Policies.Antibiotics (Basel, Switzerland) · 2024Review
- Review
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4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPrevious evidence shows that antibiotic use and antimicrobial resistance (AMR) spread are not always perfectly correlated within and between countries. We conducted an ecological analysis to evaluate how demographic, economic, governance, health, and freedom characteristics of 30 European countries contribute to antibiotic consumption and AMR.
methodsUsing three sources of data (World Bank DataBank, ECDC atlas, and the ESAC-Net database), we created a dataset of: 22 indicators of demographics, health, economic, governance, and freedom; AMR proportions for 25 combinations of pathogens and antibiotics; consumption of antibiotics in the community. We also computed five indexes of demographic, health, economic, governance, and freedom, and an aggregate AMR measure. Relationships between indexes, antibiotic consumption, and AMR proportions were explored using bivariate, multivariable, multivariate, and mediation analyses.
resultsMultivariate analysis identified three clusters of countries that mainly differed for demographic, health, governance, and freedom indexes. AMR proportion was lower in countries with better indexes (p < 0.001), but not necessarily with lower antibiotic consumption. In multivariable models including all five indexes, an increase in the governance index resulted in significant decreases of overall antibiotic consumption (p < 0.001) and AMR proportion (p = 0.006). Mediation analysis showed that the governance index had an indirect effect on AMR via reducing antibiotic consumption, which accounted only for 31.5% of the total effect.
conclusionsThese findings could be - at least partially - explained by the contagion theory, for which other factors contribute to high levels of AMR in countries with poor governance. As a result of this evidence, reducing antibiotic use alone is unlikely to solve the AMR problem, and more interventions are needed to increase governance efficiency at global level.
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