Gender Equity and AMR

Within antimicrobial resistance, like much of the healthcare delivery system, it is important to take into account gender and other forms of equity. Below are a few resources displaying the various links to equity, specifically gender equity, and antimicrobial resistance

Background Resources:

Differences in antimicrobial use and emerging antimicrobial resistance (AMR) between men and women may reflect biological differences (i.e. sex differences), socially constructed differences (i.e. gender), or a combination of the two. Sex and gender differences may impact a person’s vulnerability to disease, risk of exposure, access to care, quality of care, adherence practices, and response to treatment. Gender roles, norms, and relations will vary by context. Thus, there is clear value of applying a gender lens to potential AMR and antimicrobial stewardship interventions to ensure effective and equitable impact. WHO highlights some important considerations for gender and equity issues for tackling AMR in their 2018 working paper.

The doctor-patient interaction is an important component of quality of care. Literature suggests that the gender of both provider and patient may influence the doctor-patient interaction including contents of the consultation, the doctor’s communication style, and the drugs that are indicated and ultimately prescribed. These findings suggest that medical decisions may be affected by gender-related considerations and stereotypes, which may also have an effect on antibiotic prescribing. For example, a recent study on the influence of gender concordance on antibiotic prescribing for sore throat symptoms in the Netherlands indicated that female physicians were more likely to apply a ‘wait and see’ policy when seeing a female patients compared to other gender dyads. BMC family practice, 2018. 19(1): p. 175. Available at: https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-018-0859-6

A 2016 systematic review examined gender differences in antibiotic prescribing in the community utilizing data from 10 high-income countries. The summary estimates indicate that the amount of antibiotics prescribed to women was 25% higher, and women were 27% more likely to receive an antibiotic prescription than men. The 16-54 years age group had the highest gender discrepancy with women receiving significantly higher numbers of prescriptions for cephalosporins and macrolides than men, which was not fully explained by differences in infectious disease epidemiology. It is important to note, however, that gender differences in prescribing disappeared for the older age groups. Journal of Antimicrobial Chemotherapy, 2016. 71(7): p. 1800-1806. Available at: https://academic.oup.com/jac/article/71/7/1800/1750612

A 2019 systematic review on patient-related determinants of adherence to antibiotic treatment indicated that being male was associated with lower adherence to prescribed antibiotic treatment for themselves and as caregivers. Other sociodemographic predictors of low adherence were young age, lower income, lower educational achievement, and living alone. The same review found that simpler regimens, characterized by fewer doses and shorter duration, were associated with higher adherence for both men and women. Additionally, aspects of patient-centered care including involvement of the patient in decision-making about antibiotic use and ensuring the patient understood the prescription improved adherence to the antibiotic regimen. Clinical Microbiology and Infection, 2019. 25(1): p. 48-53. Available at: https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(18)30398-7/fulltext