Table 3.
Multinomial regression model to assess factors associated with treatment decisions for upper respiratory tract infections (URTIs) with respect to antibiotic use among Chinese university students (n=2834)
| Did not treat or self-treated without antibiotics (n=1662, 58.65%) | Self-medicated with antibiotics (n=462, 16.30%)‡ | Sought formal care (n=710, 25.05%)‡ | P value*‡ | |||||
| n (%) | n (%) | RRR (95% CI) | aRRR (95% CI)† | n (%) | RRR (95% CI) | aRRR (95% CI)† | ||
| Knowledge about antibiotics | ||||||||
| AMR awareness |
0.006 |
|||||||
| Low | 84 (5.05) | 23 (4.98) | Reference | Reference | 74 (10.42) | Reference | Reference | |
| Medium | 302 (18.17) | 94 (20.35) | 1.14 (0.68 to 1.90) | 1.34 (0.77 to 2.34) | 175 (24.65) | 0.66 (0.46 to 0.95) | 0.80 (0.54 to 1.18) | |
| High | 1276 (76.77) | 345 (74.68) | 0.99 (0.61 to 1.59) | 1.38 (0.82 to 2.33) | 461 (64.93) | 0.41 (0.29 to 0.57) | 0.61 (0.42 to 0.89) | |
| Ability to identify antibiotics | 0.49 |
|||||||
| Low | 488 (29.36) | 108 (23.38) | Reference | Reference | 210 (29.58) | Reference | Reference | |
| Medium | 718 (43.20) | 224 (48.48) | 1.41 (1.09 to 1.82) | 1.08 (0.82 to 1.43) | 325 (45.77) | 1.05 (0.85 to 1.30) | 1.08 (0.86 to 1.36) | |
| High | 456 (27.44) | 130 (28.14) | 1.29 (0.97 to 1.71) | 1.20 (0.87 to 1.67) | 175 (24.65) | 0.89 (0.70 to 1.13) | 1.27 (0.97 to 1.66) | |
| Perceived severity of the infection | ||||||||
| Common cold is self-limiting |
<0.0001 |
|||||||
| Yes | 1216 (73.16) | 297 (64.29) | Reference | Reference | 414 (58.31) | Reference | Reference | |
| No/I don’t know | 446 (26.84) | 165 (35.71) | 1.51 (1.22 to 1.89) | 1.34 (1.05 to 1.71) | 296 (41.69) | 1.95 (1.62 to 2.34) | 1.66 (1.36 to 2.02) | |
| Perceived antibiotic efficacy | ||||||||
| Perceived antibiotic efficacy for URTIs |
<0.0001 |
|||||||
| No/low | 664 (39.95) | 90 (19.48) | Reference | Reference | 184 (25.92) | Reference | Reference | |
| Medium | 813 (48.92) | 267 (57.79) | 2.42 (1.87 to 3.14) | 1.99 (1.50 to 2.64) | 396 (55.77) | 1.76 (1.44 to 2.15) | 1.46 (1.17 to 1.82) | |
| High | 185 (11.13) | 105 (22.73) | 4.19 (3.02 to 5.80) | 3.03 (2.10 to 4.38) | 130 (18.31) | 2.54 (1.92 to 3.35) | 1.89 (1.38 to 2.57) | |
| Antibiotics are anti-inflammatory drugs |
0.02 |
|||||||
| No | 1123 (67.57) | 249 (53.90) | Reference | Reference | 427 (60.14) | Reference | Reference | |
| Yes/I don’t know | 539 (32.43) | 213 (46.10) | 1.78 (1.44 to 2.20) | 1.40 (1.10 to 1.77) | 283 (39.86) | 1.38 (1.15 to 1.66) | 1.12 (0.91 to 1.38) | |
| Cues to action | ||||||||
| Severity of current infection (number of symptoms experienced) |
<0.001 |
|||||||
| Low (one symptom) | 974 (58.60) | 217 (46.97) | Reference | Reference | 297 (41.83) | Reference | Reference | |
| Medium (two symptoms) | 507 (30.51) | 152 (32.90) | 1.35 (1.07 to 1.70) | 1.30 (1.01 to 1.68) | 234 (32.96) | 1.51 (1.24 to 1.85) | 1.29 (1.04 to 1.61) | |
| High (three symptoms or more) | 181 (10.89) | 93 (20.13) | 2.31 (1.73 to 3.08) | 1.96 (1.36 to 2.84) | 179 (25.21) | 3.24 (2.54 to 4.14) | 1.64 (1.21 to 2.21) | |
| Fever |
<0.0001 |
|||||||
| No | 1432 (86.16) | 359 (77.71) | Reference | Reference | 444 (62.54) | Reference | Reference | |
| Yes | 230 (13.84) | 103 (22.29) | 1.79 (1.38 to 2.32) | 1.23 (0.89 to 1.72) | 266 (37.46) | 3.73 (3.04 to 4.58) | 2.98 (2.32 to 3.83) | |
| Barriers/access to antibiotics | ||||||||
| Keeping antibiotics at home |
<0.0001 |
|||||||
| No | 628 (37.79) | 38 (8,23) | Reference | Reference | 234 (32.96) | Reference | Reference | |
| Yes | 1034 (62.21) | 424 (91.77) | 6.78 (4.79 to 9.58) | 4.68 (3.24 to 6.74) | 476 (67.04) | 1.24 (1.03 to 1.49) | 1.24 (1.00 to 1.54) | |
| Over-the-counter purchase of non-prescription antibiotics in the past year |
<0.0001 |
|||||||
| No | 709 (42.66) | 55 (11.90) | Reference | Reference | 251 (35.35) | Reference | Reference | |
| Yes | 953 (57.34) | 407 (88.10) | 5.51 (4.09 to 7.42) | 3.21 (2.34 to 4.41) | 459 (64.65) | 1.36 (1.13 to 1.63) | 1.22 (0.99 to 1.51) | |
| Sociodemographic characteristics | ||||||||
| Age | 1.03 (0.99 to 1.07) | 1.01 (0.97 to 1.05) | 0.99 (0.96 to 1.02) | 0.99 (0.95 to 1.03) | ||||
| Sex | 0.19 |
|||||||
| Male | 876 (52.71) | 243 (52.60) | Reference | Reference | 357 (50.28) | Reference | Reference | |
| Female | 786 (47.29) | 219 (47.40) | 1.00 (0.82 to 1.23) | 1.22 (0.97 to 1.52) | 353 (49.72) | 1.10 (0.92 to 1.31) | 1.12 (0.92 to 1.35) | |
| Urbanicity of home town | 0.64 |
|||||||
| Rural | 1000 (60.17) | 273 (59.09) | Reference | Reference | 371 (52.25) | Reference | Reference | |
| Urban | 662 (39.83) | 189 (40.91) | 1.05 (0.85 to 1.29) | 1.07 (0.83 to 1.39) | 339 (47.75) | 1.38 (1.16 to 1.65) | 1.11 (0.89 to 1.38) | |
| Average household income (¥, monthly) | 0.14 |
|||||||
| >10 000 (>$1538) | 307 (18.47) | 83 (17.97) | Reference | Reference | 106 (14.93) | Reference | Reference | |
| 3001–10 000 ($462–$1538) | 907 (54.57) | 239 (51.73) | 0.97 (0.74 to 1.29) | 0.82 (0.60 to 1.12) | 357 (50.28) | 1.14 (0.89 to 1.47) | 1.07 (0.82 to 1.41) | |
| ≤3000 ($461) | 448 (26.96) | 140 (30.30) | 1.16 (0.85 to 1.57) | 0.97 (0.67 to 1.41) | 247 (34.79) | 1.60 (1.22 to 2.09) | 1.37 (0.99 to 1.89) | |
| Self-efficacy for healthcare decisions | ||||||||
| Major in medicine |
0.03 |
|||||||
| No | 1365 (82.13) | 397 (85.93) | Reference | Reference | 634 (89.30) | Reference | Reference | |
| Yes | 297 (17.87) | 65 (14.07) | 0.75 (0.56 to 1.01) | 0.89 (0.64 to 1.25) | 76 (10.70) | 0.55 (0.42 to 0.72) | 0.68 (0.50 to 0.91) | |
| Having at least one parent with medical background | 0.34 |
|||||||
| No | 1488 (89.53) | 395 (85.50) | Reference | Reference | 641 (90.28) | Reference | Reference | |
| Yes | 174 (10.47) | 67 (14.50) | 1.45 (1.07 to 1.96) | 1.27 (0.91 to 1.78) | 69 (9.72) | 0.92 (0.69 to 1.23) | 1.00 (0.72 to 1.37) | |
| Region (University, Province) |
<0.0001 |
|||||||
| North (NKU, Tianjin) | 276 (16.61) | 81 (17.53) | Reference | Reference | 60 (8.45) | Reference | Reference | |
| East (ZJU, Zhejiang) | 310 (18.65) | 38 (8.23) | 0.42 (0.27 to 0.63) | 0.50 (0.32 to 0.79) | 111 (15.63) | 1.65 (1.16 to 2.35) | 1.86 (1.27 to 2.73) | |
| Southwest (GZU, Guizhou) | 240 (14.44) | 84 (18.18) | 1.19 (0.84 to 1.69) | 0.98 (0.66 to 1.44) | 169 (23.80) | 3.24 (2.30 to 4.56) | 2.49 (1.72 to 3.60) | |
| Northwest (LZU, Gansu) | 287 (17.27) | 103 (22.29) | 1.22 (0.88 to 1.71) | 1.08 (0.75 to 1.56) | 138 (19.44) | 2.21 (1.57 to 3.12) | 1.92 (1.33 to 2.77) | |
| South (WHU, Hubei) | 297 (17.87) | 50 (10.82) | 0.57 (0.39 to 0.85) | 0.66 (0.43 to 1.00) | 133 (18.73) | 2.06 (1.46 to 2.91) | 2.39 (1.66 to 3.45) | |
| Northeast (JLU, Jilin) | 252 (15.16) | 106 (22.94) | 1.43 (1.02 to 2.01) | 1.10 (0.76 to 1.60) | 99 (13.94) | 1.81 (1.26 to 2.60) | 1.37 (0.93 to 2.03) | |
*Likelihood ratio tests for treatment decisions for URTIs.
†Adjusted for age, sex, household income, urbanicity, university major in medicine, having at least one parent with medical background and region/province.
‡Bold values denote statistical significance at the p < 0.05 level.
AMR, antimicrobial resistance; aRRR, adjusted relative risk ratio; RRR, relative risk ratio.