Table 1.
Demographics, comorbidities, and antibiotic exposures of the Veterans Affairs (VA) outpatients with antibiotic prescriptions in 2010–2020 by rurality.
| Demographics, Clinical Characteristics, and Antibiotics | All VA Outpatients (n = 1,405,642) |
Rural-Residing Veterans (n = 320,320) |
Urban-Residing Veterans (n = 1,085,322) |
|---|---|---|---|
| Age, years, mean (standard deviation) | 58.9 (16.5) | 60 .7 (15. 7 ) | 58 .3 (16. 7 ) |
| Male | 1,240,607 (88.3) | 289,301 (90.3) | 951,306 (87.7) |
| Race | |||
| Black | 264,286 (18.8) | 28,784 (9) | 235,502 (21.7) |
| White | 1,012,373 (72) | 266,080 (83.1) | 746 ,293 (68 .8) |
| Other | 128,983 (9.2) | 25,456 (7.9) | 103,527 (9.5) |
| Hispanic or Latino | 80,338 (5.7) | 7555 (2.4) | 72,783 (6. 7 ) |
| Married | 679,007 (48.3) | 174,970 (54 .6) | 504,037 (46.4) |
| Region of the VA facility | |||
| Northeast | 195,292 (13.9) | 35,769 (11.2) | 159,523 (14.7) |
| South | 651,218 (46.3) | 150,946 (47.1) | 500,272 (46. 1 ) |
| Midwest | 309,192 (22) | 92,800 (29.0) | 216,392 (19. 9 ) |
| West | 249,940 (17.8) | 40,805 (12.7) | 209,135 (19. 3 ) |
| Charlson score higher than the median a | 689,918 (49.1) | 168,087 (52.5) | 521,831 (48.1 ) |
| Elixhauser score higher than the median b | 549,107 (39.1) | 129,796 (40.5) | 419,311 (38.6) |
| Comorbidities | |||
| Cerebrovascular disease | 81,640 (5.8) | 19,620 (6.1) | 62,020 (5.7) |
| Alcohol disorder | 137,772 (9.8) | 27,779 (8.7) | 109,993 (10. 1 ) |
| Atherosclerosis | 214,987 (15.3) | 57,054 (17.8) | 157,933 (14.6) |
| Cancer or malignancy | 315,275 (22.4) | 76,118 (23 .8) | 239,157 (22) |
| Chronic kidney disease | 90,950 (6.5) | 20,722 (6.5) | 70,228 (6.5) |
| Chronic pulmonary disease | 229,020 (16.3) | 61,205 (19. 1 ) | 167,815 (15.5) |
| Cognitive disorders | 59,077 (4.2) | 12,249 (3. 8 ) | 46,828 (4. 3) |
| Congestive heart failure | 73,988 (5.3) | 18,219 (5. 7 ) | 55,769 (5.1 ) |
| Depression | 297,322 (21.2) | 66,277 (20. 7 ) | 231,045 (21.3) |
| Diabetes mellitus | 411,669 (29.3) | 100,249 (31. 3 ) | 311,420 (28.7) |
| Drug abuse | 88,609 (6.3) | 15,144 (4. 7 ) | 73,465 (6. 8 ) |
| Hypertension | 734,535 (52.3) | 180,169 (56.2) | 554,366 (51. 1) |
| Liver disease | 53,231 (3.8) | 10,138 (3.2) | 43,093 (4) |
| Myocardial infarction | 29,420 (2.1) | 7535 (2. 4 ) | 21,885 (2) |
| Obesity | 250,600 (17.8) | 59,134 (18.5) | 191,466 (17.6) |
| Peptic ulcer disease | 12,602 (0.9) | 3150 (1) | 9452 (0.9 ) |
| Peripheral vascular disease | 85,432 (6.1) | 21,473 (6. 7 ) | 63,959 (5.9 ) |
| Pulmonary heart disease | 20,892 (1.5) | 4665 (1.5) | 16,227 (1.5) |
| Thyroid disorder | 11,1239 (7.9) | 27,646 (8. 6 ) | 83,593 (7. 7 ) |
| Infection diagnosis | |||
| Upper respiratory tract infection | 782,090 (55.6) | 180,502 (56.4) | 601,588 (55.4) |
| Pneumonia | 105,381 (7.5) | 25,847 (8.1) | 79,534 (7.3) |
| Urinary tract infection | 222,867 (15.9) | 49,245 (15.4) | 173,622 (16) |
| Skin and soft tissue infection | 336,970 (24) | 74,205 (23.2) | 262,765 (24.2) |
| Duration of antibiotics, days, median (IQR) | 9 (5–10) | 10 ( 5– 10) | 8 (5–10) |
| Antibiotic agents * | |||
| Amoxicillin | 111,523 (7.9) | 24,788 (7.7) | 86,735 (8) |
| Amoxicillin/clavulanate | 251,029 (17.9) | 57,457 (17.9) | 193,572 (17.8) |
| Azithromycin | 309,658 (22) | 66,898 (20.9) | 242,760 (22.4) |
| Cefuroxime | 15,401 (1.1) | 5021 (1. 6 ) | 10,380 (1 ) |
| Cephalexin | 134,703 (9.6) | 30,198 (9.4 ) | 104,505 (9.6) |
| Ciprofloxacin | 123,640 (8.8) | 28,703 (9) | 94,937 ( 8 .7 ) |
| Clindamycin | 58,317 (4.1) | 12,550 (3.9 ) | 45,767 (4.2) |
| Doxycycline | 121,218 (8.6) | 27,360 (8.5) | 93,858 (8.6) |
| Levofloxacin | 54,019 (3.8) | 13,277 (4.1) | 40,742 (3.8) |
| Moxifloxacin | 74,232 (5.3) | 19,134 (6) | 55,098 (5.1) |
| Nitrofurantoin | 22,423 (1.6) | 4796 (1.5) | 17,627 (1.6) |
| Penicillin | 12,188 (0.9) | 2133 (0.7 ) | 10,055 (0 .9) |
| Sulfamethoxazole/trimethoprim | 176,881 (12.6) | 40,526 (12.7) | 136,355 (12.6) |
| Antibiotic classes * | |||
| Penicillinsc | 123,902 (8.8) | 26,982 (8.4) | 96,920 (8.9) |
| Cephalosporins d | 150,503 (10.7) | 35,296 (11) | 115,207 (10.6) |
| Macrolidese | 319,765 (22.8) | 69,451 (21.7) | 250,314 (23.1) |
| Fluoroquinolones f | 250,909 (17.9) | 60,890 (19) | 190,019 (17.5) |
| Beta-lactams with increased activity g | 251,042 (17.9) | 57,463 (17.9) | 193,579 (17.8) |
| Tetracyclines h | 128,753 (9.2) | 28,892 (9) | 99,861 (9.2) |
| Urinary tract antibiotics i | 198,682 (14.1) | 45,173 (14.1) | 153,509 (14.1) |
The data are n (%) unless otherwise indicated. The categorical variables were compared using the chi-squared or Fisher’s exact tests where appropriate, the means were compared using t-tests, and the medians were compared using nonparametric Wilcoxon tests. Bold indicates the p-value < 0.05. * Counts and percentages are not mutually exclusive as the patients may have had multiple antibiotic exposures during their treatment course. We included the first outpatient antibiotic treatment course (including all antibiotics from the start to the end of treatment). a Those with a Charlson comorbidity score higher than the median were compared to those with a median Charlson comorbidity score. The median Charlson comorbidity score was 0. b Those with a Elixhauser score higher than the median were compared to those with a median Elixhauser score or lower. The median Elixhauser score was 2. c Penicillins: amoxicillin, ampicillin, penicillin. d Cephalosporins: cefaclor, cefadroxil, cefazolin, cefotetan, cefoxitin, cefprozil, cefuroxime, cephalexin. e Macrolides: azithromycin, clarithromycin, erythromycin. f Fluoroquinolones: ciprofloxacin, levofloxacin, moxifloxacin. g Beta-lactams with increased activity: amoxicillin/clavulanate, ampicillin/sulbactam. h Tetracyclines: tetracycline, minocycline, doxycycline. i Urinary tract antibiotics: sulfamethoxazole/trimethoprim, fosfomycin, nitrofurantoin.