# The impact of socioeconomic status on the prevalence of antimicrobial resistance in high-income nations: a systematic review

## TL;DR

This paper reviews how socioeconomic factors influence antimicrobial resistance in high-income countries, finding that lower income and education are linked to higher resistance rates.

## Contribution

This study is the first systematic review to explore the relationship between socioeconomic status and AMR prevalence specifically in high-income nations.

## Key findings

- Lower socioeconomic status correlates with higher AMR prevalence, particularly for MRSA infections.
- Indices like income and household density are consistently linked to increased AMR rates.
- Variability in SES metrics limits generalizability, and some AMR strains show exceptions to the trend.

## Abstract

Antimicrobial resistance (AMR) poses an escalating global threat, transforming once-treatable infections into major health challenges. Although antibiotic misuse is a well-known driver of AMR, particularly in low- and middle-income settings, the silent epidemic may be fueled by socioeconomic disparities even in high-income countries. This systematic review investigates the relationship between socioeconomic status (SES) and AMR prevalence across high-income nations based on the World Bank classification.

The studies included in this review span multiple observational designs (cross-sectional, cohort, and case-control) across various high-income nations, assessing the association between SES indicators (eg, income, education, and household crowding) and AMR strains, primarily methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Escherichia coli.

Findings consistently indicate that lower SES correlates with higher AMR prevalence, particularly in MRSA infections (r = 0.76, Blakiston et al). The review highlights that indices of SES (often derived from government census data) are consistently associated with lower income, lower educational attainment, and increased household density with elevated AMR prevalence.

The variability among studies in SES metrics, including income measures and deprivation indices, limits generalizability. Exceptions to this trend, noted in select studies focusing on distinct AMR strains like ceftriaxone-resistant E. coli, underscore the complexity of SES-related AMR mechanisms. This review supports public health initiatives aimed at targeting low-SES communities with AMR mitigation strategies, advocating for continued monitoring and intervention to curb AMR spread in vulnerable populations.