Exploring equity, gender and social determinants aspects of antimicrobial resistance: Scoping review

Abstract

Abstract Background Antimicrobial resistance (AMR) is a considerable threat to modern medicine and global health. Inequity, gender and social determinants of health (SDH) have a significant impact on health and health services, including in relation to AMR. Despite this, there is a lack of systematic focus on these dimensions in AMR research, policy and practice. We aimed to scope and review the existing evidence related to the equity, gender and SDH considerations for AMR globally through a systematic, iterative approach. Methods We conducted a scoping review by searching PubMed, Web of Science and CINAHL for empirical research on AMR in humans, with consideration of equity, gender or SDH, published in English between January 2000 and September 2019. In a two-stage process, we analysed full texts to extract information about explicit and then implicit references to equity, gender or SDH. Results The search yielded 4628 articles after removing 578 duplicates. 737 articles were analysed with explicit reference to equity, gender or SDH in title or abstract. Preliminary results show that 93.2% of these studies mentioned gender but mostly meaning biological sex (90.8%) rather than its social construct. Articles on equity (6.0%) and SDH (1.1%) reported on associations between AMR rates and income and non-income dimensions of inequality, health system issues and disadvantaged subpopulations within countries. Other articles in this category explored public and policy discourse or approaches for AMR (0.8%) and equity issues for AMR-related R&D (0.7%). These results combined with the PROGRESS-Plus acronym informed the subsequent analysis of the 4628 articles for implicit considerations of equity, gender and SDH. Conclusions Despite casting a wide net, we found relatively little research explicitly considering equity, gender and SDH aspects of AMR especially at a systematic or structural level. This reflects an important gap in the current understanding of and efforts to tackle AMR. Key messages We conducted a scoping review on equity, gender and social determinants considerations of AMR that indicates limited research on these important aspects of the social and structural drivers of AMR. Further research on these aspects is essential to inform the design of effective policy and practice interventions that target vulnerable groups and address structural inequities.