Global antimicrobial-resistance drivers: an ecological country-level study at the human–animal interface
"We found significant associations between AMR and several socioeconomic factors. Results from the multivariable analysis showed significant positive associations between human AMR and the GINI index (WHO critical priority), and increased mortality rate attributable to either unsafe WASH (WHO medium priority) or to cardiovascular complications (WHO critical priority). Significant negative associations were found with GDP (WHO high priority), and national monitoring systems for sales, prescription, and consumption of antibiotics in humans (WHO critical priority). Therefore, our models are consistent with previous literature, showing that factors indicative of lower socioeconomic status are associated with higher levels of AMR in humans.
9 These associations are probably explained by the uncontrolled dissemination of resistant bacteria that can occur in settings in which sanitation services are inadequate and access to health care is reduced.
Governance indicators were closely, and intuitively, linked with AMR in animals and humans. Significant negative associations were found with rule of law (animal), regulatory quality (WHO medium priority), voice and accountability (WHO high priority), and control of corruption (WHO critical priority). The order of magnitude of effect was considerable, with halved odds of carbapenem-resistant A baumanii, carbapenem-resistant P aeruginosa, and third generation cephalosporins-resistant E coli, all associated with more reliable governance. This corroborates earlier reports describing the contributions of poor governance and corruption to human AMR, 46 but our results expand their importance to the One Health context".