The Potential Patterns of Symptoms of Upper Respiratory Tract Infections in the Public and Their Effects on Antibiotic Use Behavior

doi:10.12114/j.issn.1007-9572.2023.0298

Abstract

Abstract:

Background

Antibiotic resistance caused by antibiotic abuse has become a public health issue worldwide. Reducing the irrational use of antibiotics for upper respiratory tract infections (URTIs) among the public is an important strategy to address the antibiotics abuse in China. Therefore, identifying the characteristics of URTIs in the population and their influence on the irrational use of antibiotics can help to design more targeted policies and interventions.

Objective

To quantify the potential patterns of symptoms of URTIs in the pulic, and explore their effect on antibiotic use behavior.

Methods

The public in three counties (districts) of Chongqing Municipality from July 20 to August 2, 2022 were selected as the survey respondents by using the cluster random sample method. The symptoms of URTIs, antibiotic use behavior, antibiotic use knowledge and demographics of the public were collected. Latent class analysis was used to identify the potential patterns of the public URTIs symptoms. Multivariate Logistic regression analysis was used to explore the influence of URTIs potential patterns on antibiotic use behavior.

Results

In this study, a total of 815 participants were included. Among them, 30.06% (245/815) of the respondents purchased antibiotics from pharmacies without a prescription, while 14.72% (120/815) of the respondents self-medicated with antibiotics for URTIs. The public knowledge level regarding rational antibiotic use was relatively low, with an average score of (2.3±1.7) points. Four symptom patterns for upper respiratory tract infections identified by latent class analysis regarding the disease pattern of URTIs, including 93 cases (11.41%) in the diverse symptoms group, 124 (15.21%) cases in the systemic symptoms group, 282 cases (34.60%) in the nasalpharyngeal symptoms group, and 316 cases (38.77%) in the mild symptoms group. The results of multivariate Logistic regression analysis showed that compared with the mild symptoms group, the nasal-pharyngeal symptoms group had a higher probability of purchasing antibiotics without a prescription (OR=1.538, P<0.05) and the association remained significant after adjusting for knowledge and demographic variables. In addition to the potential patterns of individual disease symptoms, age and medical insurance type also had a significant impact on the non-prescription antibiotic purchasing behavior of the public (P<0.05). There was a significant effect of antibiotic usage knowledge level on self-medication behavior with antibiotics (OR=0.869, P<0.05) and non-prescription antibiotic purchasing behavior of the public (OR=1.155, P<0.05) .

Conclusion

There are four potential patterns of symptoms of URTIs in the public. Patterns of disease symptoms significantly influence the rational use of antibiotics by the public. The focus should be on the irrational use of antibiotics in patients presenting with nasopharyngeal symptoms.

Key words: Respiratory tract infections, Anti-bacterial agents, Rational use of antibiotics, Signs and symptoms, Latent class analysis, Logistic models

摘要： 背景抗生素滥用导致的耐药问题已成全球重大公共卫生议题，减少公众上呼吸道感染的抗生素不合理使用是我国治理抗生素滥用的重要策略，识别上呼吸道感染疾病病症特点及其对抗生素不合理使用行为的影响有助于临床医生设计更为精准的干预政策。目的定量分析公众上呼吸道感染症状的潜在模式，探究其对抗生素使用行为的影响。方法本研究采用整群随机抽样调查，于2022-07-20—08-02选取重庆市三个县（区）的人群作为调查对象。调查公众上呼吸道感染疾病症状、公众上呼吸道感染抗生素使用行为、公众抗生素使用知识及人口学特征。采用潜在类别分析方法鉴别公众上呼吸道感染疾病症状的潜在模式，采用多因素Logistic回归分析探索不同潜在症状模式对抗生素使用行为的影响。结果 815位公众参与本研究。其中，30.06%（245/815）受访者存在无处方从药店购买抗生素，14.72%（120/815）受访者使用过抗生素自我药疗以应对上呼吸道感染。公众抗生素合理使用知识水平较低[（2.3±1.7）分]。上呼吸道感染疾病发病模式方面，潜在类别分析共识别4种症状模式，包括多重症状组93例（11.41%）、全身症状组124例（15.21%）、鼻咽症状组282例（34.60%）和轻微症状组316例（38.77%）。多因素Logistic回归分析结果显示：相较于轻微症状组，鼻咽症状组出现无处方购买抗生素行为的概率更高（OR=1.538，P<0.05），该结果在调整知识与人口学变量后仍显著。除个体疾病症状潜在模式外，年龄和医保类型也对公众无处方抗生素购药行为有影响（P<0.05）。抗生素使用知识水平对抗生素自我药疗行为有影响（OR=0.869，P<0.05），对公众无处方抗生素购药行为也有影响（OR=1.155，P<0.05）。结论公众上呼吸道感染症状存在4种潜在模式，疾病病症模式影响公众抗生素的合理使用，应着重关注出现鼻咽症状患者的抗生素不合理使用行为。

关键词: 呼吸道感染, 抗菌药, 抗生素合理使用, 体征和症状, 潜在类别分析, Logistic模型

ZHANG Xinyi,WANG Xi,WANG Dan, et al. The Potential Patterns of Symptoms of Upper Respiratory Tract Infections in the Public and Their Effects on Antibiotic Use Behavior[J]. Chinese General Practice, 2024, 27(05): 527-534. DOI: 10.12114/j.issn.1007-9572.2023.0298.
张欣怡,王茜,王丹等. 公众上呼吸道感染症状的潜在模式及其对抗生素使用行为的影响研究[J]. 中国全科医学, 2024, 27(05): 527-534. DOI: 10.12114/j.issn.1007-9572.2023.0298.

Figures/Tables 6

References 26

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变量	名数	百分数（%）
性别
男	319	39.14
女	496	60.86
年龄
19~39岁	307	37.67
40~64岁	357	43.80
≥65岁	151	18.53
受教育程度
小学及以下	275	33.74
初中	188	23.07
高中或中专	114	13.99
大专及以上	238	29.20
本人或家人医学背景
有	144	17.67
无	671	82.33
保险类型
城镇职工保险	228	27.98
城乡居民保险	226	27.73
新农合	342	41.96
其他	19	2.33
慢性病情况
有	404	49.57
无	411	50.43
家庭年收入
<20 000元	224	27.48
20 000~59 999元	278	34.11
60 000~119 999元	200	24.54
≥120 000元	113	13.87
健康状况自评
很差	20	2.45
较差	61	7.48
一般	199	24.42
良好	249	30.55
健康	286	35.10

变量	名数	百分数（%）
性别
男	319	39.14
女	496	60.86
年龄
19~39岁	307	37.67
40~64岁	357	43.80
≥65岁	151	18.53
受教育程度
小学及以下	275	33.74
初中	188	23.07
高中或中专	114	13.99
大专及以上	238	29.20
本人或家人医学背景
有	144	17.67
无	671	82.33
保险类型
城镇职工保险	228	27.98
城乡居民保险	226	27.73
新农合	342	41.96
其他	19	2.33
慢性病情况
有	404	49.57
无	411	50.43
家庭年收入
<20 000元	224	27.48
20 000~59 999元	278	34.11
60 000~119 999元	200	24.54
≥120 000元	113	13.87
健康状况自评
很差	20	2.45
较差	61	7.48
一般	199	24.42
良好	249	30.55
健康	286	35.10

症状编号	症状	名数	百分数（%）
1	咳嗽	573	70.31
2	喷嚏	461	56.56
3	鼻塞	440	53.99
4	清水样鼻涕	405	49.69
5	黏稠样鼻涕	109	13.37
6	咽痒	218	26.75
7	咽痛	351	43.07
8	咽肿大	54	6.63
9	吞咽疼痛	112	13.74
10	低热	108	13.25
11	畏寒	67	8.22
12	头痛	356	43.68
13	声音嘶哑	88	10.80
14	呼吸不畅	70	8.59
15	扁桃体肿大	122	14.97
16	食欲不振	122	14.97
17	乏力	187	22.94
18	其他	65	7.98

症状编号	症状	名数	百分数（%）
1	咳嗽	573	70.31
2	喷嚏	461	56.56
3	鼻塞	440	53.99
4	清水样鼻涕	405	49.69
5	黏稠样鼻涕	109	13.37
6	咽痒	218	26.75
7	咽痛	351	43.07
8	咽肿大	54	6.63
9	吞咽疼痛	112	13.74
10	低热	108	13.25
11	畏寒	67	8.22
12	头痛	356	43.68
13	声音嘶哑	88	10.80
14	呼吸不畅	70	8.59
15	扁桃体肿大	122	14.97
16	食欲不振	122	14.97
17	乏力	187	22.94
18	其他	65	7.98

模型	K	Log（L）	AIC	BIC	aBIC	Entropy	LMR	BLRT	类别概率
1	18	-7 037.00	14 110.00	14 194.66	14 137.50				1.000
2	37	-6 601.65	13 277.29	13 451.31	13 333.82	0.862	<0.001	<0.001	0.178/0.822
3	56	-6 518.37	13 148.74	13 412.12	13 234.29	0.851	0.005	<0.001	0.112/0.119/0.769
4	75	-6 458.88	13 067.77	13 420.51	13 182.34	0.878	<0.001	<0.001	0.120/0.146/0.327/0.407
5	94	-6 422.83	13 033.67	13 475.77	13 177.26	0.770	0.819	<0.001	0.112/0.261/0.143/0.147/0.330