Reanalyzing the Economic Burden of Antimicrobial Resistance: Socioeconomic Inequality and Local Policy Recommendations in U.S. Low-and Middle-Income Regions

Antimicrobial resistance (AMR) is one of the greatest global and public health crises of the modern age. AMR has contributed to increased healthcare costs, prolonged hospitalization, reduced productivity, and rising mortality rates worldwide. While AMR is commonly viewed as a global threat, existing studies fail to account for socioeconomic disparities present in low- and middle-income countries (LMICs) and low- and middle-income regions (LMIRs) within high-income countries such as the United States. This study investigates how socioeconomic vulnerabilities in LMIRs in the United States affect contributors to AMR’s economic burden and identifies policy interventions that could improve domestic AMR containment strategies. Because direct healthcare expenditures were not measured, this study utilized surveillance capacity, AMR-related outbreak rates, antibiotic prescription patterns, diagnostic capacity, and supply shortages as established proxies for factors that influence the economic burden of AMR. This study utilized a mixed-methods research design combining targeted survey data from physicians, health economists, and healthcare administrations with secondary data analysis from public health databases. The results show that higher socioeconomic vulnerability was associated with lower diagnostic and infrastructural capacity and increased supply shortages. These disparities support the implementation of local policy changes, including expanded rapid diagnostic technologies, improved antimicrobial stewardship programs, standardized surveillance systems, increased healthcare funding, and broader educational initiatives.