Last week, I argued that the link between antibiotic use and obesity, diabetes, and stroke had little to do with the effects of antibiotics on the microbiome (the microorganisms that live in and on us), and much to do with the link between ill health and infection. It turns out that the data were prescription data (i.e., not hospital consumption).
I still think what I argued is still the most probable explanation (although two areas that definitely need study are the walk-in clinics and drugstore/retailer clinics such as those found in Walmart). Many surgical procedures end up with prescriptions being filled outside the hospital (obviously, if someone is on life support, this doesn’t apply). In my own recent experience, surgery and related issues led to me taking 25 doses of antibiotics. All but three of those doses were purchased at a pharmacy, and were not administered at a hospital, even though the use of the antibiotics was surgery-related (i.e., I didn’t go to a doctor and ask for antibiotics).
The other issue is that patients who are poor (i.e., don’t have health insurance, or ‘good’ health insurance), while they are able to receive emergency treatment, they are released far earlier than someone with health insurance. They are told to leave and get antibiotics externally, as opposed to receiving treatment in the hospital (this policy can have horrifying consequences).
One final thought: another neglected area is the role of dentistry. Many people with pre-existing conditions (including diabetes) often take antibiotics as a preventative measure before or after dental procedures. As far as I can tell, all of this would be not be counted as hospital use.