E antibiotics amoxicillin, doxycycline, and co-amoxiclav (amoxicillin with clavulanic acid) given that these drugs are most usually, yet not especially, prescribed for pneumonia in adults, according to prevailing qualified guidelines with the Dutch College of Basic Practitioners (NHG) plus the Dutch working Group on Antibiotic Policy (SWAB) [24,39]. Nitrofurantoin was incorporated as a control antibiotic, considering the fact that this drug is exclusively utilized for urinary tract infections. Only data from persons aged 15 years and older were integrated as other antibiotics are advisable to treat pneumonia in children [39]. 4.4. Exclusion Criteria and Confounding Aspects Antibiotic use is dependent on age as older RH01687 site adults (aged 65) use extra antibiotics per capita than younger adults [28,29]. Additionally, female sex is related with high prescribing [29,31,40]. UDPs with missing values for gender and/or five-year age groups have been removed. The five-year age groups were regrouped into 5 new groups: 154 years (adolescent), 254 (young adult), 454 (adult), 654 (senior), and 75 (elder). Information on the total population size of each PC4 location by gender and five-year age category have been collected from Statistics Netherlands for the year 2015 [41]. All PC4 regions with less than one hundred inhabitants have been excluded. Commercial poultry and goat farms are seldom discovered in urban regions; on the other hand, other environmental risk things, which include traffic-related air pollution, are present. PC4 regions that scored 1 (extremely sturdy, 2500 addresses per km2) or 2 (powerful, 1500500 addresses per km2) on urbanization were hence excluded. Urbanization scores per PC4 area were collected from Statistics Netherlands for 2014. Various studies have shown the influence of socio-economic aspects on the consumption of antibiotics [26,28,30]. The SES per PC4 area was collected in the Netherlands Institute for Social Investigation for the year 2014. SES was expressed as a status score according to population traits (educational level, revenue, and labor market participation) of each and every PC4 area, and was divided into quartiles: low (-0.22), low-medium (-0.22 and 0.42), medium-high (-0.42 and 0.96), and higher (0.96). PC4 areas with missing data on SES were excluded. Smoking is linked with an enhanced risk of CAP as tobacco increases the susceptibility to bacterial lung infection [42,43]. The percentage of smokers per PC4 area was offered from the RIVM well being monitor [44] and was divided in quartiles: low (17), low-medium (17 and 19), medium-high (19 and 21), and higher (21). four.five. Statistical Analysis We used descriptive statistics to describe the traits on the population of UDPs with and devoid of poultry or goat farms. For each antibiotic, we calculated the total quantity of prescriptions and also the imply DDD per 1000 inhabitants. The amoxicillin, doxycycline,Antibiotics 2021, 10,9 ofco-amoxiclav, and nitrofurantoin use, the presence of poultry and goat farms, as well as the SES distribution have been visualized in maps applying a Geographical Facts Method. We initial explored associations in between antibiotic use and poultry and goat farm exposure variables in crude two-by-two associations utilizing Chi-square analysis. In the most important analyses, the number of DDDs per UDP, that is a count variable, was used because the outcome variable. Initial data exploration utilizing Poisson regression showed that the ratio of deviance to degrees of freedom Faldaprevir-d6 site varied from 15.10 (amoxicillin) to 30.62 (doxycycline), indicating severe overdispersion on the outcome v.
