Introduction:
Only a few studies have assessed the relationship between deprivation and excessive antibiotic use. In Texas, antimicrobial prescription rates are particularly high compared with the rest of the US. This study analyzed the association between local area socioeconomic deprivation and providers’ fluoroquinolone claim rates among beneficiaries 65 years and older in Texas.

Methods:
This ecological study utilized provider- and area-level data from Medicare Part D Prescribers and the Social Deprivation Index (SDI) repositories. Negative binomial regression models were employed to evaluate the relationship between provider- and area-level characteristics (prescriber’s gender, specialty, rural-urban community area, beneficiaries’ demographics, area-level population, and SDI) and fluoroquinolone claim rates per 1,000 beneficiaries.

Results:
A total of 11,996 providers were included. SDI (IRR 0.98, 95% CI 0.97–0.99) and male providers (IRR 0.96, 95% CI 0.94–0.99) were inversely associated with claim rates. In contrast, several factors were associated with higher claim rates, including non-metropolitan areas (1.04, 95% CI 1.00–1.09), and practices with a high proportion of male (IRR 1.12, 95% CI 1.10–1.14), Black (IRR 1.05, 95% CI 1.03–1.07), or Medicaid beneficiaries (IRR 1.15, 95% CI 1.12–1.17). Effect modification was observed between SDI and rurality, with higher SDI in non-metropolitan areas associated with higher claim rates, whereas SDI in metropolitan areas was inversely related to claim rates.

Conclusion:
Lower fluoroquinolone claim rates were observed among Texas Medicare providers in metropolitan areas with higher SDI. Conversely, higher rates were observed in rural areas with higher SDI. More studies are needed to understand the underlying causes of this variation and develop effective stewardship interventions.