Socioeconomic position and urban environments as drivers of antimicrobial resistance? An ecological study in Germany, 2010 to 2019
BACKGROUND Germany lacks comprehensive studies on the relationship between socioeconomic position (SEP) and antimicrobial resistance (AMR). AIM We assessed the association between area-level SEP and AMR infection and colonisation in Germany. METHODS In an ecological study design, we analysed statuto...
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European Centre for Disease Prevention and Control
2025-07-01
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| Series: | Eurosurveillance |
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| Online Access: | https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2025.30.28.2400723 |
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| author | Niels Michalski |
| author_facet | Niels Michalski |
| author_sort | Niels Michalski |
| collection | DOAJ |
| description | BACKGROUND Germany lacks comprehensive studies on the relationship between socioeconomic position (SEP) and antimicrobial resistance (AMR). AIM We assessed the association between area-level SEP and AMR infection and colonisation in Germany. METHODS In an ecological study design, we analysed statutory notifications of invasive meticillin-resistant Staphylococcus aureus (MRSA, n = 34,440) in 2010−2019, and colonisations and infections with carbapenem-resistant Acinetobacter spp. (CRA, n = 1,979) and Enterobacterales (CRE, n = 10,825) in 2017−2019. Area-level SEP was measured by the German index of socioeconomic deprivation (GISD), incorporating education, employment and income data. A multilevel Poisson regression analysis estimated the association between AMR incidence and GISD at district level, adjusting for age, sex, notification year and urbanisation degree. RESULTS Median ages of patients with carbapenem-resistant bacteria were between 66 (CRA colonisation) and 69 years (CRE infection). For MRSA infections, the median age was 74 years. Across each pathogen, approximately two thirds of patients were male. Estimated MRSA incidence was almost five times higher in districts with lowest vs highest area-level SEP (incidence rate ratio, IRR: 4.8; 95% CI: 2.8–8.2). This association was strongest in large cities (IRR: 9.1; 95% CI: 2.7–30.9), and sparsely populated rural districts (IRR: 6.5; 95% CI: 2.8–15.0). Associations of CRA (IRR: 0.6; 95% CI: 0.3–1.2) and CRE (IRR: 0.9; 95% CI: 0.6–1.4) infections with SEP were not statistically significant. CONCLUSION Lower area-level SEP and degree of urbanisation were associated with MRSA incidence, however, no associations were uncovered between SEP and CRA or CRE infections. Further individual-level research could explore if health behaviours, living/working conditions or healthcare access explain the findings. Socioeconomic conditions should be considered for AMR prevention and control. |
| format | Article |
| id | doaj-art-4548b800d8974ad9b7d2eaa3bbc5fde3 |
| institution | DOAJ |
| issn | 1560-7917 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | European Centre for Disease Prevention and Control |
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| series | Eurosurveillance |
| spelling | doaj-art-4548b800d8974ad9b7d2eaa3bbc5fde32025-08-20T03:12:54ZengEuropean Centre for Disease Prevention and ControlEurosurveillance1560-79172025-07-01302810.2807/1560-7917.ES.2025.30.28.2400723http://instance.metastore.ingenta.com/content/eurosurveillance/30/28Socioeconomic position and urban environments as drivers of antimicrobial resistance? An ecological study in Germany, 2010 to 2019Niels Michalski0These authors contributed equally to this work and share last authorship.BACKGROUND Germany lacks comprehensive studies on the relationship between socioeconomic position (SEP) and antimicrobial resistance (AMR). AIM We assessed the association between area-level SEP and AMR infection and colonisation in Germany. METHODS In an ecological study design, we analysed statutory notifications of invasive meticillin-resistant Staphylococcus aureus (MRSA, n = 34,440) in 2010−2019, and colonisations and infections with carbapenem-resistant Acinetobacter spp. (CRA, n = 1,979) and Enterobacterales (CRE, n = 10,825) in 2017−2019. Area-level SEP was measured by the German index of socioeconomic deprivation (GISD), incorporating education, employment and income data. A multilevel Poisson regression analysis estimated the association between AMR incidence and GISD at district level, adjusting for age, sex, notification year and urbanisation degree. RESULTS Median ages of patients with carbapenem-resistant bacteria were between 66 (CRA colonisation) and 69 years (CRE infection). For MRSA infections, the median age was 74 years. Across each pathogen, approximately two thirds of patients were male. Estimated MRSA incidence was almost five times higher in districts with lowest vs highest area-level SEP (incidence rate ratio, IRR: 4.8; 95% CI: 2.8–8.2). This association was strongest in large cities (IRR: 9.1; 95% CI: 2.7–30.9), and sparsely populated rural districts (IRR: 6.5; 95% CI: 2.8–15.0). Associations of CRA (IRR: 0.6; 95% CI: 0.3–1.2) and CRE (IRR: 0.9; 95% CI: 0.6–1.4) infections with SEP were not statistically significant. CONCLUSION Lower area-level SEP and degree of urbanisation were associated with MRSA incidence, however, no associations were uncovered between SEP and CRA or CRE infections. Further individual-level research could explore if health behaviours, living/working conditions or healthcare access explain the findings. Socioeconomic conditions should be considered for AMR prevention and control.https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2025.30.28.2400723Regional disparitiesSocioeconomic factorsAntimicrobial drug resistanceAcinetobacterMeticillin-resistant Staphylococcus aureusEnterobacterales |
| spellingShingle | Niels Michalski Socioeconomic position and urban environments as drivers of antimicrobial resistance? An ecological study in Germany, 2010 to 2019 Eurosurveillance Regional disparities Socioeconomic factors Antimicrobial drug resistance Acinetobacter Meticillin-resistant Staphylococcus aureus Enterobacterales |
| title | Socioeconomic position and urban environments as drivers of antimicrobial resistance? An ecological study in Germany, 2010 to 2019 |
| title_full | Socioeconomic position and urban environments as drivers of antimicrobial resistance? An ecological study in Germany, 2010 to 2019 |
| title_fullStr | Socioeconomic position and urban environments as drivers of antimicrobial resistance? An ecological study in Germany, 2010 to 2019 |
| title_full_unstemmed | Socioeconomic position and urban environments as drivers of antimicrobial resistance? An ecological study in Germany, 2010 to 2019 |
| title_short | Socioeconomic position and urban environments as drivers of antimicrobial resistance? An ecological study in Germany, 2010 to 2019 |
| title_sort | socioeconomic position and urban environments as drivers of antimicrobial resistance an ecological study in germany 2010 to 2019 |
| topic | Regional disparities Socioeconomic factors Antimicrobial drug resistance Acinetobacter Meticillin-resistant Staphylococcus aureus Enterobacterales |
| url | https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2025.30.28.2400723 |
| work_keys_str_mv | AT nielsmichalski socioeconomicpositionandurbanenvironmentsasdriversofantimicrobialresistanceanecologicalstudyingermany2010to2019 |