Association of factors linked to health inequalities and the risk of antibiotic-resistant infection in high-income countries: a systematic scoping review

This scoping review examined how health inequalities influence the risk of antibiotic-resistant infections (ARIs) in high-income countries. From 331 papers screened (2010–2024), 18 studies were included—mainly from the USA, UK, New Zealand, and Australia.

The review found that ethnicity, socioeconomic deprivation, and age were key determinants of ARI risk. In the USA, Black patients had 2–3 times higher MRSA rates than White patients, while Indigenous Australians and Māori populations in New Zealand also faced disproportionately high rates of resistant infections. Hispanic patients showed higher rates of penicillin-resistant Streptococcus pneumoniae. Resistance in E. coli, Enterococcus, Klebsiella, and Pseudomonas correlated with low income and high deprivation, and income inequality across Europe was linked with higher resistance overall.

Accounting for socioeconomic factors substantially reduced apparent racial disparities, suggesting that social and economic inequalities are major underlying drivers. Overall, the review underscores that antibiotic resistance disproportionately affects ethnic minorities and socioeconomically disadvantaged groups, highlighting the need to address inequality in AMR prevention and control efforts.