ABSTRACT
Background. Declines in outpatient antibiotic prescribing were reported during the beginning of the COVID-19 pandemic in the United States;however, the overall impact of COVID-19 cases on antibiotic prescribing remains unclear. Methods. We conducted an observational, ecological study to assess the impact of COVID-19 cases and pandemic-related, non-pharmaceutical interventions (NPIs) (e.g., school closures and facemasks) on antibiotic prescribing from February to December 2020 in the US. A random effects panel regression of county-level monthly reported COVID-19 case data and corresponding systemic antibiotic prescription data from IQVIA was used. The model controlled for county demographics, NPIs, and prior years' prescribing. Results. Total antibiotic prescriptions fell 26.1% between March and December 2020 compared to this period from 2017 to 2019. Prescribing rates dropped most among children (Figure 1). A 1% increase in county-level monthly COVID-19 cases was associated with a 0.9% increase (95% CI 0.7%, 1.1%;p< 0.01) in monthly prescriptions dispensed to adults and a 1.2% decrease (95% CI -1.7%, -0.8%;p< 0.01) in prescriptions dispensed to children (Table 1). Counties with schools open for in-person instruction were associated with a 4.4% increase (95% CI 2.3%, 6.4%;p< 0.01) in prescriptions among children compared to counties that closed schools. Internal movement restrictions and requiring facemasks were also associated with lower prescribing among children. Figure 1 A) Total prescriptions per 100,000 population by month (2017-2020). B) Mean prescriptions per 100,000 population for seven age groups (2017-2019 vs 2020). Table 1 Conclusion. Though the number of antibiotic prescriptions in 2020 was lower than previous years, the positive association of COVID-19 cases with prescribing for adults and the negative association for children indicates increases in prescribing occurred primarily among adults. The rarity of bacterial co-infection in COVID-19 patients suggests a large fraction of these prescriptions may have been inappropriate. Facemasks and school closures were correlated with reductions in prescribing among children, likely due to the prevention of other upper respiratory infections (e.g., the cold and influenza). Despite reductions, the strongest predictors of prescribing were prior years' prescribing trends, suggesting the possibility that behavioral norms are an important driver of prescribing practices.
ABSTRACT
Purpose : Emerging evidence suggests that the COVID-19 pandemic, which has disproportionately affected people of African descent (AD), is disrupting health behaviors such as medication adherence. Studies have not yet assessed, however, whether medication adherence is differentially affected in people of AD, a population shown to have poorer adherence prior to the pandemic. We examined whether racial disparities exist in the impact of the COVID-19 pandemic on medication adherence in people of AD and European descent (ED). Methods : We used a controlled interrupted time series design in which the interruption was the declaration of the COVID-19 pandemic in the United States on March 13, 2020. The 300-day follow-up period, which bracketed this declaration, started on October 16, 2019 and ended on August 10, 2020. Patients were selected from an ongoing longitudinal NIH-funded study initiated prior to the onset of the pandemic, if they had primary openangle glaucoma, were prescribed ocular hypotensive medication and had adherence data spanning the 300 days of the study. The primary outcome was daliy adherence defined as the number of doses taken divided by the number of doses prescribed, expressed as a percentage. Adherence was measured objectively using Medication Event Monitoring System (MEMS). Segmented regression analysis using the slope change following a lag impact model was performed and the Davies test was used to compare the slopes in the periods preceding and following the pandemic. Results : 72 patients (35 of AD and 37 of ED) were included. Prior to the pandemic, mean adherence was 75 ± 25% in patients of AD and 91 ± 15% in people of ED (p = 0.001). In patients of AD, the slopes in the periods preceding (0.0% / day) and following (-0.07% / day) the pandemic were significantly different (p < 0.001). In patients of ED, the slopes in the periods preceding (0.01% / day) and following (-0.02 / day) the pandemic were similar (p = 0.05). Conclusions : Medication adherence, a health behavior critical in the management of chronic diseases, was adversely affected by the COVID-19 pandemic in patients of African descent with glaucoma. The vulnerabilities exposed by the COVID-19 pandemic should be used to inform the development of interventions that will ensure continued use of medication during crisis periods, particularly in high-risk populations.