Despite limited research into this area, there is evidence to suggest that people from Black, Asian and Minority Ethnic (BAME) communities are more likely to get antibiotic-resistant infections. It also indicates that they have worse health outcomes when they do. There are many diverse reasons as to why this might be the case; we explore some of the research so far.
Antibiotic Research UK is the world’s first charity dedicated solely to fighting back against antibiotic resistance in order to preserve these precious medicines for future generations. This issue is of major importance because such infections can affect anyone, regardless of age, health, ethnicity or socioeconomic status. We are all at risk, and we all have a part to play in overcoming this challenge.
That is why research that suggests people from BAME communities are unduly affected by antibiotic-resistant infections is of such concern. Long-standing research shows that any difference in disease burden between ethnic groups is not related to biological differences, but rather the societal effects of the race/ethnicity of the individuals [1]. This can easily be demonstrated by the fact that there is greater genetic diversity within ethnic groups than there is between them.
Put simply, if people from BAME communities are suffering worse health outcomes than white people, it is not because they are biologically different. It is because of the impact of their ethnic background on other factors, such as how they receive medical advice and treatment, where they live, the work they do, their income and their diet. It is not right that this happens, and by better understanding this issue and the impact it has, we are more likely to be able to come up with solutions.
Here, we use research into bacterial infections of the gut and MRSA to highlight the evidence that antibiotic-resistant infections disproportionately affect people from diverse ethnic backgrounds.
Differences in gastric infection rates
One US study examined data from a 10-year period and found that the proportion of Shigella samples (a food-borne disease-causing bacteria) that were found to be resistant to a specific type of antibiotic (trimethoprim-sulfamethoxazole) was [2]:
- 40% in white people
- 58% in Hispanic people
- 75% in people with a history of international travel.
A study in the Netherlands showed that patients with Helicobacter pylori (a stomach-disease causing bacteria) were significantly more likely to have an antibiotic-resistant strain if they were of Turkish descent or from Africa or the Middle East (35% resistant to metronidazole and 9.1% to clarithromycin), compared with ethnic Dutch people (21% resistant to metronidazole and 2.9% to clarithromycin) [3].
In the UK, another study found that in patients from two ethnically diverse boroughs of London, who were suffering from indigestion and had samples taken that were positive for H. pylori [4]:
- 59% of the total samples were resistant to metronidazole and 11% were resistant to clarithromycin (8% were resistant to both); this is twice the rate of metronidazole-resistant pylori found in other UK-studies.
- Of patients born outside of the UK, 68% of samples were resistant to metronidazole.
- Of patients born in the UK, 40% of samples were resistant to metronidazole.
The authors in this study did not take living conditions, eating patterns or other factors into account. Please use caution when interpreting these results.
Differences in MRSA rates
One study explored the reasons behind the fact that a higher proportion of people of colour (POC) in the USA suffer from invasive community-acquired MRSA than white people. This type of MRSA is not acquired during hospital treatment. The research demonstrated that 91% of this disparity was due to the following factors [5]:
- Living in medically under-served areas
- Education level
- Housing value
- Income
- Rural status
The researchers concluded that “no significant association of race with community-associated MRSA remained”. Other studies have shown that being ‘not white’ puts you at greater risk of MRSA infection in a variety of contexts: in prisoners [6]; in hospital patients [7]; in children [8]; in people in care homes [9].
What does this mean?
Using just two examples of types of bacterial infections, we can see that simply being from a BAME community means you are at a higher risk of contracting an antibiotic-resistant infection. We have previously looked at how people from BAME communities experience worse healthcare-related outcomes, too, so it’s no great stretch to imagine that once affected, the impact of these infections is much worse in people who are not caucasian. As the number of antibiotic-resistant infections continues to increase, we need to act now. If we don’t another pandemic is coming that will further highlight the inequalities still present in our society.
Help change things for the better
Antibiotic-resistant infections can affect anyone, but they disproportionately affect people from BAME communities. Our research does not discriminate, and we offer support to anyone affected by such infections. If you would like to contribute towards research that benefits everyone in the world, please make a donation today.
References
- Cooper & David, 1986. J Health Polit Policy Law 11(1):97-116.
- Shiferaw et al, 2012. Clin Infect Dis 54(Suppl 5):S458-63.
- Loffeld & Fijen, 2003. Clin Microbiol Infect 9:600-4.
- Elviss et al, 2005. J Med Microbiol 54:567-74.
- See et al, 2017 Clin Infect Dis 64(5):597-604.
- Haysom et al, 2018 J Correct Health 24(2):197-213.
- Kallen et al, 2010 JAMA 304(6):641-7.
- Immergluck et al, 2019 BMC Infect Dis 19:170
- Roghmann et al, 2015 Infect Control Hosp Epidemiol 36(9):1050-7.
Further Reading
Some of these studies and more are explored in further detail in the Race Equality Foundation’s Better Health Briefing (43) on The burden of antimicrobial-resistant infections in black and minority ethnic groups (PDF).