148 Chapter 6 Determinants An earlier systematic literature review was conducted to identify determinants associated with appropriate antimicrobial prescribing (1). Following that review, other potential determinants not yet investigated were defined, including migration background, household income, number of parents per household and day of antimicrobial prescription. Patient level Included determinants on patient level were age, gender, comorbidity, migration background, household income and number of parents in household. Comorbidities that implied an immunosuppressed state, as listed in supplement 1, were merged into a composite comorbidity variable. For the calculation of this composite variable the presence of each comorbidity was counted as 1, added together as a count variable and referenced against the absence of comorbidities. We defined 4 comorbidity categories: 0, 1, 2 and 3 or more, and defined patients with 3 or more comorbidities as 1 group. Household income was divided into 3 groups based on the definition of the Dutch Standardized Income (14). In The Netherlands 33,500 euro per year was the modal household income between 2012 and 2022 (14). Our low income group had a household income of < 33,500 euro and was used as a reference group. Our middle income group had a household income between 33,500 and 67,000 euros and our high income group had a household income of > 67,000 euro. Migration background was defined by SN as the country with which a person is connected based on the country of birth of one’s parents or oneself (15). Migration background was categorized into seven groups according to SN definitions: Dutch, Dutch-Caribbean, Moroccan, Surinamese, Turkish and Global South and Global North. A Dutch background was used as the reference group. Number of parents in household was classified as a dichotomous variable of either one or two parents, with a two-parent household as the reference group. Practice level Included determinants on the General Practice level were practice population size and day of prescription. During the study period, a primary care practice size of 2,168 patients was defined as the norm for The Netherlands by the Dutch Healthcare Authority (16). For the analyses, primary care practices were categorized into three groups according to the average size of their practice. A small practice was defined as <2,168 registered patients (and used as a reference), a medium size practice had
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