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Differences in antibiotic treatment and utilization of diagnostic tests in Dutch primary care between natives and non-western immigrants

Abstract Background: Different expectations and demands of non-western immigrants may prompt physicians to deviate from their routine clinical management strategies resulting in more diagnostic tests and higher prescription rates. Antibiotic prescription is of specific importance, since overuse of antibiotics is a major public health concern. No data are available about possible differences in antibiotic prescription rates between natives and non-western immigrants in Europe. Objectives: To determine whether ethnic origin is an independent determinant for the frequency of antibiotic treatment and additional diagnostic tests in primary care patients with infectious diseases. Methods: In this cross-sectional study, 1015 non-western immigrants were compared to 995 native Dutch, all selected from the Utrecht Health Project database. Data were analysed using multiple logistic regression analyses. Antibiotics most frequently used in Dutch primary care were included in the analyses. For the analyses of additional diagnostic tests, only respiratory tract infections were included, since these are the most common infectious diseases for which general practitioners are contacted. Results: First generation non-western immigrants were more likely to undergo diagnostic tests and received more antibiotics than native Dutch (respectively OR: 2.08; 95% CI: 1.64–2.63; and OR: 1.31; 95% CI: 1.04–1.65). No differences were found for the second generation immigrants. The results found were independent of potential confounders. Conclusions: The highest rates of antibiotic prescription and diagnostic tests concern first generation non-western immigrants. In order to promote a rational and restricted use of antibiotics in outpatients first generation immigrants should be a prioritized target group.