Racial Differences in Respiratory Tract Infection Diagnosis and Antibiotic Prescriptions

BACKGROUND: Non-White patients are less likely than White patients to be prescribed antibiotics for respiratory tract infections (RTIs). Our objective was to understand whether this could be explained by differences in RTI diagnosis type by race. METHODS: We conducted an observational cohort study of adults receiving urgent care at Cleveland Clinic in Northeast Ohio who were diagnosed with an RTI between 2016 and 2022. We used mixed effects logistic regression of antibiotic prescription by patient race (White versus non-White) in two models: 1) not accounting for RTI diagnosis type, and 2) accounting for diagnosis type. We used mixed effects logistic regression, including physician and individual patient as random effects, to assess differences in the odds of being diagnosed with sinusitis versus unspecified RTI by race. Finally, we assessed odds of being prescribed an antibiotic by race, stratified by diagnosis. Analyses were conducted at the visit level. RESULTS: Among 100,052 visits with 62,972 unique patients (median visits per patient was 1), 21% percent were for sinusitis and 30% were for unspecified RTI. Eighty-four percent of patients were White and 16% were non-White. In the model not controlling for diagnosis, compared to White patients, non-White patients were significantly less likely to be prescribed an antibiotic (aOR: 0.79; 95%CI:0.76-0.82). After adjusting for diagnosis, the association between non-White race and antibiotic prescription was weaker but still significant (aOR:0.91; 95%CI:0.87-0.95). Compared to White patients, non-White patients were significantly less likely to be diagnosed with sinusitis versus unspecified RTI (aOR:0.61; 95%CI:0.56-0.66). Non-White patients were significantly less likely to be prescribed antibiotics for sinusitis and unspecified RTI than White patients. CONCLUSIONS: Racial differences in diagnosis of sinusitis partially explain lower rates of antibiotic prescription among non-White patients.