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Inequality in quality? Regional and educational differences in treatment with fluoroquinolone in urinary tract infection of 236 376 Swedish patients
  1. R Ljung1,2,
  2. A Reimers2,3,
  3. Ö Ericsson1,
  4. B Burström2,3
  1. 1Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden
  2. 2Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  3. 3Social Medicine Unit, Stockholm Centre for Public Health, Stockholm County Council, Stockholm, Sweden
  1. Correspondence to Rickard Ljung, Centre for Epidemiology, National Board of Health and Welfare, Stockholm 106 30, Sweden; rickard.ljung{at}


Background In an international effort to reduce antibiotic resistance, in part suggested to be the effect of inappropriate antibiotic use, several quality indicators for outpatient antibiotic use have been proposed. In this study, geographical and educational differences in fluoroquinolone prescription in the treatment of urinary tract infection in women are presented.

Methods The age-adjusted ratio of women who were dispensed fluoroquinolones (ciprofloxacin or norfloxacin) among all 236 376 women dispensed any of the following antibiotics used in the treatment of lower urinary tract infection were studied: ciprofloxacin, norfloxacin, pivmecillinam, trimethoprim and nitrofurantoin. Only the first prescription during July 2006 to June 2007 was studied. Prescription data were linked to information on geographical area, marital status, country of birth and educational attainment, which allowed multivariate analysis of the importance of these factors.

Results The rate of fluoroquinolone prescription varied from 29.5% to 17.1% in the 21 regions in Sweden. Middle-aged women with ≥15 years of schooling were more often prescribed fluoroquinolones compared to those with only 9 years (OR 1.28, 95% CI 1.23 to 1.34).

Conclusion Quality indicators in healthcare should be developed bearing in mind the overall level of adherence to guidelines and whether there are regional or socioeconomic or other differentials in their distribution in the population because such differentials in healthcare quality might further contribute to inequalities in health.

  • Antibiotics
  • fluoruquinolones
  • socioeconomic factors
  • urinary tract infection
  • Sweden
  • primary care
  • drug therapy
  • healthcare quality
  • antibiotics

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  • Anne Reimers sadly died in August 2008.

  • Funding Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden. Social Medicine Unit, Stockholm Centre for Public Health, Stockholm County Council.

  • Competing interests None.

  • Ethical approval The Swedish National Board of Health and Welfare is a governmental agency and may according to Swedish law use the population-based registers to follow and analyse health and social circumstances in the population, and data were made available to us in such a way that individuals could not be identified.

  • Provenance and peer review Not commissioned; externally peer reviewed.