Antimicrobial resistance and people living with disabilities
Authors: Yusuff Adebayo Adebisi
Journal: The Lancet (2024)

The intersection of antimicrobial resistance (AMR) and disability is a crucial yet underexplored area in population health. The global challenge of AMR, claiming more than 700 000 lives annually, demands attention to its potential disproportionate effect on individuals with high risk of contracting infections, particularly people with disabilities.1Murray CJL Ikuta KS Sharara F et al.Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis.Lancet. 2022; 399: 629-655Summary Full Text Full Text PDF PubMed Scopus (4847) Google Scholar About 16% of the global population, or roughly 1·3 billion people, live with substantial disabilities.2WHODisability.https://www.who.int/news-room/fact-sheets/detail/disability-and-health/Date accessed: December 12, 2023Google Scholar This great portion of the population necessitates attention in health-care planning and policy. The burden of AMR presents a major concern for people with disabilities. Due to a combination of biological factors and health-care-related issues, these individuals might be at a higher risk of AMR. They often require frequent health-care visits for routine care, treatment of their disabilities, or management of other health conditions. This consistent interaction with health-care settings exposes them to environments where antibiotics are heavily used and can become breeding grounds for antibiotic-resistant bacteria. Moreover, some people with disabilities frequently contend with chronic conditions or weakened immune systems.3Dieudonné Y Uring-Lambert B Jeljeli MM et al.Immune defect in adults with Down syndrome: insights into a complex issue.Front Immunol. 2020; 11: 840Crossref PubMed Scopus (23) Google Scholar, 4Manikam L Schilder AGM Lakhanpaul M Littlejohns P Alexander EC Hayward A Respiratory tract infection-related health care utilisation in children with Down's syndrome.Infection. 2020; 48: 403-410Crossref PubMed Scopus (4) Google Scholar This vulnerability underscores the key need for careful antimicrobial use in these populations. Furthermore, the reliance on medical devices—a common aspect for those with conditions such as spinal cord injuries or severe cerebral palsy—greatly increases these individuals' exposure to potential sources of drug-resistant bacteria. Adding to this complexity, the high prevalence of mental health disorders within this demographic poses additional challenges for medication adherence—a major concern for antimicrobial stewardship. Furthermore, socioeconomic factors, such as living in poverty and low level of education, disproportionately affect people with disabilities and might play a major role in their risk of AMR burden.5Frier A Barnett F Devine S Barker R Understanding disability and the 'social determinants of health': how does disability affect peoples' social determinants of health?.Disabil Rehabil. 2018; 40: 538-547Crossref PubMed Scopus (52) Google Scholar These factors contribute to barriers in accessing health care, leading to delayed or inappropriate treatment of infections—a situation that greatly elevates the risk of AMR among this demographic. Moreover, the role of health literacy and effective communication cannot be overstated. For individuals with disabilities, the absence of health information tailored to their specific needs can result in the misuse of antibiotics, further exacerbating the AMR crisis. Therefore, an inclusive AMR strategy should: incorporate disability considerations into policy and action plans; improve health-care access through professional training on disability awareness and antibiotic use; and provide health literacy materials in accessible formats. Governments, health-care providers, and disability advocates must collaborate, ensuring the rights of individuals with disabilities are respected. I declare no competing interests.