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

Introduction: Antibiotic-resistant infections (ARIs) disproportionately affect vulnerable populations, yet research of health inequalities in ARIs is limited. This scoping review explores the relationship between health inequalities factors and the risk of ARI in high-income countries. Methods: We searched Ovid Embase, Ovid MEDLINE All and Google Scholar for studies from high-income countries between January 2010 and February 2024. Health inequalities factors assessed included socioeconomic status, protected characteristics and vulnerable groups. Studies on sexually transmitted, foodborne, viral and fungal infections were excluded. Results: Of 331 papers reviewed, 18 were included. Studies were from the USA (12), UK (2), New Zealand (2) and Australia (1). Staphylococcus aureus was the most studied pathogen, with ethnicity, deprivation and age as key factors examined. In the USA, Black patients had MRSA rates 2–3 times higher than White patients, despite overall declines. Indigenous Australians also had elevated rates compared with non-indigenous populations. When socioeconomic factors and age were accounted for, racial disparities in MRSA were significantly reduced. Hispanic patients had higher rates of Streptococcus pneumoniae penicillin-resistant infections than non-Hispanic White patients. Escherichia coli resistance was more prevalent in low-income or high-deprivation groups, with ethnic minorities in New Zealand also disproportionately affected. Helicobacter pylori was most common in Māori populations compared with other ethnicities, and income inequality correlated with resistance in Enterococcus, Klebsiella and Pseudomonas across Europe. Conclusions: We highlight the potential impact of factors associated with health inequalities on the risk of ARIs, with higher rates of resistant infection associated with ethnic minorities and income inequalities.