Socioeconomic inequalities in the self-reported use of antibiotics in the European Union, 2009-2022: a repeated cross-sectional analysis
File(s)
Published version
Author(s)
Patel, Meera
Filippidis, Filippos
Type
Journal Article
Abstract
Objectives: This study aims to explore trends in the use of antibiotics, in the context of the COVID-19 pandemic, across the European Union (EU), focusing on socioeconomic inequalities.
Design: Repeated cross-sectional analysis.
Setting: 26 EU Member States.
Participants: Analyses were conducted using data from five waves of the Eurobarometer survey (2009-2022, n=127,299).
Primary and secondary outcome measures: We used multilevel logistic regression, stratified by financial difficulty, to examine changes in past-year use of
antibiotics and in obtaining antibiotics inappropriately over time, adjusting for gender, age, type of community, children under-10 in household and antibiotic-related
knowledge.
Results: We found that the odds of self-reported use of antibiotics decreased between 2009 and 2022 in those with (Odds Ratio [OR]=0.59, 95% Confidence Interval [CI]:0.55-0.63) and without financial difficulties (OR=0.53, 95%CI:0.50-0.56), with a substantial reduction between 2018 and 2022. However, a relatively higher proportion of Europeans who used antibiotics in the past year were obtaining them inappropriately in those with (OR=2.03, 95%CI:1.68-2.45) and without financial difficulties (OR=1.83, 95%CI:1.53-2.19) in 2022. Among those with financial difficulties, higher self-reported use of antibiotics and inappropriately obtaining antibiotics were associated with lesser knowledge about antibiotics.
Conclusions: Despite notable progress made in the EU in reducing antibiotic use, current efforts fall short in addressing the issue of inappropriate antibiotic use. A
targeted approach prioritising outreach to vulnerable populations to advance attitudes and behaviours related to appropriate antibiotic use may be required to
achieve further progress.
Strengths and limitations of this study
• We analysed data covering 26 countries over a 13-year period.
• We used consistent measures across countries and over time.
• The cross-sectional study design limits causal inference.
• Data on antibiotic use are self-reported and do not include information on frequency and duration.
Design: Repeated cross-sectional analysis.
Setting: 26 EU Member States.
Participants: Analyses were conducted using data from five waves of the Eurobarometer survey (2009-2022, n=127,299).
Primary and secondary outcome measures: We used multilevel logistic regression, stratified by financial difficulty, to examine changes in past-year use of
antibiotics and in obtaining antibiotics inappropriately over time, adjusting for gender, age, type of community, children under-10 in household and antibiotic-related
knowledge.
Results: We found that the odds of self-reported use of antibiotics decreased between 2009 and 2022 in those with (Odds Ratio [OR]=0.59, 95% Confidence Interval [CI]:0.55-0.63) and without financial difficulties (OR=0.53, 95%CI:0.50-0.56), with a substantial reduction between 2018 and 2022. However, a relatively higher proportion of Europeans who used antibiotics in the past year were obtaining them inappropriately in those with (OR=2.03, 95%CI:1.68-2.45) and without financial difficulties (OR=1.83, 95%CI:1.53-2.19) in 2022. Among those with financial difficulties, higher self-reported use of antibiotics and inappropriately obtaining antibiotics were associated with lesser knowledge about antibiotics.
Conclusions: Despite notable progress made in the EU in reducing antibiotic use, current efforts fall short in addressing the issue of inappropriate antibiotic use. A
targeted approach prioritising outreach to vulnerable populations to advance attitudes and behaviours related to appropriate antibiotic use may be required to
achieve further progress.
Strengths and limitations of this study
• We analysed data covering 26 countries over a 13-year period.
• We used consistent measures across countries and over time.
• The cross-sectional study design limits causal inference.
• Data on antibiotic use are self-reported and do not include information on frequency and duration.
Date Issued
2026-03-01
Date Acceptance
2026-02-18
Citation
BMJ Open, 2026, 16 (3)
ISSN
2044-6055
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open
Volume
16
Issue
3
Copyright Statement
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY- NC. No commercial re-use. See rights and permissions. Published by BMJ Group.
License URL
Publication Status
Published
Article Number
108513
Date Publish Online
2026-03-09