Poverty and corruption as determinants of global antimicrobial resistance

Abstract

Antimicrobial resistance is a major threat to global public health and is believed to cause over 700,000 deaths per year. Efforts to tackle this problem have tended to focus on reducing antibiotic consumption and promoting the appropriate use of medicines. This study examines the relative importance of other socio-economic factors, more specifically poverty (Gross National Income per capita) and corruption (measured by quality of governance), in determining antibiotic resistance compared to use of antibiotics. Using panel data of 48 countries in 2008-2017, a fixed-effects multivariate analysis was used. Sobel tests and mediation analyses were also carried out to determine the extent to which the effects of poverty and corruption on antimicrobial resistance were mediated through other explanatory variables in the model, including human antibiotic usage, healthcare expenditure, access to basic sanitation and the availability of medical personnel. Poverty and corruption were found to be significant factors in determining the level of resistance. No significant association was found between antibiotic consumption and resistance, and health expenditure as a proportion of government expenditure was found to be the only variable with a mediating effect (for poverty) in determining the level of antibiotic resistance. This is the first study to examine antimicrobial resistance and its association with poverty and corruption using panel data and including countries outside Europe. The findings support the hypothesis that poor governance and poverty contribute to levels of antibiotic resistance and population health.