1. CULTURAL AND SOCIOECONOMIC DETERMINANTS OF ANTIBIOTIC CONSUMPTION IN THE U.S. Megan Orlando Health Grand Challenge 2011 Center for Disease Dynamics, Economics & Policy

2. Internship Details  The Center for Disease Dynamics, Economics & Policy (CDDEP) in Washington, D.C.  Non-profit organization committed to using research to support better decision-making in health policy  My project fit in with CDDEP’s Extending the Cure report, which characterizes antibiotic resistance as a shared societal problem and evaluates policies to improve antibiotic use

3. Research Question  What are the relevant social, economic and cultural factors that influence antibiotic use at the county level in the United States?  Consumption literature focuses mostly on Europe  Regional comparisons in the U.S. do not use most recent local data  Can we perform a statistical analysis on new data to create a consumption function?

4. Data  IMS Health provided antibiotic sales data by ZIP-code for the calendar year 2007  Independent variables included demographic, socioeconomic, health status, climate and environmental health variables  State-level resistance data included in the consumption function  Regional dummy variables used to proxy for cultural factors

5. Consumption Patterns

7. Model Results  Upon regression analysis, regional dummies are always significant, indicating an unexplained cultural factor  Income is consistently negatively associated with antibiotic consumption  Consumption function includes over 15 significant variables, models are still being refined

8. Summary  This was my first long-term global health research project and allowed me to investigate domestic cultural and social determinants of antibiotic use  This project is one of the first statistical analyses of consumption at the county level in the United States  I hope to use this research as the basis for my senior independent work