The intersection of the social determinants of health and antimicrobial resistance in human populations: a systematic review.

introductionThe social determinants of health (SDoH) impact the emergence and spread of antimicrobial resistance (AMR). We conducted a systematic review of literature mapping evidence on the intersection of SDoH, drug-resistant infections, antibiotic use, and public-facing interventions.

methodsFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Ovid MEDLINE, Ovid EMBASE, the Cochrane Library, PsycINFO and Scopus were searched for published evidence in English between 2000 and 2022. Covidence software was used for data extraction. The evidence was mapped to the SDoH frameworks and the systematic review objectives.

resultsOf 17 252 retrieved papers, 16 636 were included in title and abstract review, with 153 included in data extraction (126 empirical studies and 27 papers with secondary data). Of these, 92/126 (73%) were quantitative, 23/126 (18%) qualitative and 11/126 (9 %) mixed methods. There was evidence from high income 60/126 (47%), lower-middle income 41/126 (33%), low income 14 (11%) and upper-middle income 11 (9%) countries.There is limited evidence associated with the complete range of SDoH in different populations. Reported determinants affecting the risk of exposure to and spread of AMR include (a) socioeconomic status and the associated impact on health seeking behaviours, (b) housing-living in a deprived area and overcrowding and (c) knowledge linked with education affecting practices, exacerbated by interconnected complexity with the associated influence of socioeconomic status. A gap in understanding the upstream systems which create inequality and negatively impact SDoH is evident. Numerous definitions are used to identify vulnerable populations. There is very limited research examining specific population groups, for example, traveller communities and the disabled. Reported interventions focus on awareness programmes with little evidence on sustained behaviour change.

conclusionsThis review identified the need to (a) develop policies and context-specific solutions to manage upstream determinants, (b) include population groups where current evidence is limited and (c) prioritise community-based research using co-production methods.