Mapping socioeconomic factors driving antimicrobial resistance in humans: An umbrella review.

Introduction: Antimicrobial resistance (AMR) is one of the biggest public health challenges of our time. National Action Plans have failed so far to effectively address socioeconomic drivers of AMR, including the animal and environmental health dimensions of One Health.
Objective: To map what socioeconomic drivers of AMR exist in the literature with quantitative evidence.
Methods: An umbrella review was undertaken across Medline, Embase, Global Health, and Cochrane Database of Systematic Reviews, supplemented by a grey literature search on Google Scholar. Review articles demonstrating a methodological search strategy for socioeconomic drivers of AMR were included. Two authors extracted drivers from each review article which were supported by quantitative evidence. Drivers were grouped thematically and summarised narratively across the following three layers of society: People & Public, System & Environment, and Institutions & Policies.
Results: The search yielded 6300 articles after deduplication, with 23 review articles included. 27 individual thematic groups of drivers were identified. The People & Public dimensions contained the following themes: age, sex, ethnicity, migrant status, marginalisation, sexual behaviours, socioeconomic status, educational attainment, household composition, maternity, personal hygiene, lifestyle behaviours. System & Environment yielded the following themes: household transmission, healthcare occupation, urbanicity, day-care attendance, environmental hygiene, regional poverty, tourism, animal husbandry, food supply chain, water contamination, and climate. Institutions & Policies encompassed poor antibiotic quality, healthcare financing, healthcare governance, and national income. Many of these contained bidirectional quantitative evidence, hinting at conflicting pathways by which socioeconomic factors drive AMR.
Conclusion: This umbrella review maps socioeconomic drivers of AMR with quantitative evidence, providing a macroscopic view of the complex pathways driving AMR. This will help direct future research and action on socioeconomic drivers of AMR.
Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Elias Mossialos reports financial support was provided by World Economic Forum. Victoria Saint reports a relationship with World Health Organization that includes: consulting or advisory. Victoria Saint reports a relationship with German Alliance for Global Health Research that includes: funding grants. Victoria Saint reports a relationship with ERASMUS Programme that includes: travel reimbursement. Alison Shutt reports a relationship with National Institute for Health Research that includes: funding grants. Esmita Charani reports a relationship with Pfizer that includes: speaking and lecture fees. Esmita Charani reports a relationship with bioMérieux Inc. that includes: speaking and lecture fees. Esmita Charani reports a relationship with World Health Organization that includes: funding grants. Esmita Charani reports a relationship with Wellcome Trust that includes: funding grants. Michael Anderson reports a relationship with World Health Organization Regional Office for Europe that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(© 2025 The Authors.)