{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:49:21Z","timestamp":1792043361871,"version":"4.4.0"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J GEN INTERN MED"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Non-White patients are less likely than White patients to be prescribed antibiotics for respiratory tract infections (RTIs). Our objective was to understand whether this could be explained by differences in RTI diagnosis type by race.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an observational cohort study of adults receiving urgent care at Cleveland Clinic in Northeast Ohio who were diagnosed with an RTI between 2016 and 2022. We used mixed effects logistic regression of antibiotic prescription by patient race (White versus non-White) in two models: 1) not accounting for RTI diagnosis type, and 2) accounting for diagnosis type. We used mixed effects logistic regression, including physician and individual patient as random effects, to assess differences in the odds of being diagnosed with sinusitis versus unspecified RTI by race. Finally, we assessed odds of being prescribed an antibiotic by race, stratified by diagnosis. Analyses were conducted at the visit level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 100,052 visits with 62,972 unique patients (median visits per patient was 1), 21% percent were for sinusitis and 30% were for unspecified RTI. Eighty-four percent of patients were White and 16% were non-White. In the model not controlling for diagnosis, compared to White patients, non-White patients were significantly less likely to be prescribed an antibiotic (aOR: 0.79; 95%CI:0.76\u20130.82). After adjusting for diagnosis, the association between non-White race and antibiotic prescription was weaker but still significant (aOR:0.91; 95%CI:0.87\u20130.95). Compared to White patients, non-White patients were significantly less likely to be diagnosed with sinusitis versus unspecified RTI (aOR:0.61; 95%CI:0.56\u20130.66). Non-White patients were significantly less likely to be prescribed antibiotics for sinusitis and unspecified RTI than White patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Racial differences in diagnosis of sinusitis partially explain lower rates of antibiotic prescription among non-White patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11606-026-10930-5","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:36:29Z","timestamp":1792042589000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Racial Differences in Respiratory Tract Infection Diagnosis and Antibiotic Prescriptions"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9177-480X","authenticated-orcid":false,"given":"Kathryn A.","family":"Martinez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ava","family":"Rezaee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Criswell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B.","family":"Rothberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"issue":"2","key":"10930_CR1","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.annemergmed.2023.12.003","volume":"84","author":"E Klein","year":"2024","unstructured":"Klein E, Saheed M, Irvin N, et al. Racial and Socioeconomic Disparities Evident in Inappropriate Antibiotic Prescribing in the Emergency Department. Ann Emerg Med. 2024;84(2):101-110. https:\/\/doi.org\/10.1016\/j.annemergmed.2023.12.003.","journal-title":"Ann Emerg Med."},{"issue":"3","key":"10930_CR2","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1097\/JXX.0000000000000834","volume":"35","author":"A Thapa","year":"2023","unstructured":"Thapa A, Champion JD. Identification of provider and patient characteristics associated with antibiotic prescription in the treatment of acute sinusitis. J Am Assoc Nurse Pract. 2023;35(3):192-198. https:\/\/doi.org\/10.1097\/JXX.0000000000000834.","journal-title":"J Am Assoc Nurse Pract."},{"issue":"1","key":"10930_CR3","doi-asserted-by":"publisher","first-page":"e184","DOI":"10.1017\/ash.2022.329","volume":"2","author":"AM Seibert","year":"2022","unstructured":"Seibert AM, Hersh AL, Patel PK, et al. Urgent-care antibiotic prescribing: An exploratory analysis to evaluate health inequities. Antimicrob Steward Healthc Epidemiol. 2022;2(1):e184. https:\/\/doi.org\/10.1017\/ash.2022.329.","journal-title":"Antimicrob Steward Healthc Epidemiol."},{"issue":"2","key":"10930_CR4","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1017\/ice.2014.21","volume":"36","author":"TF Barlam","year":"2015","unstructured":"Barlam TF, Morgan JR, Wetzler LM, Christiansen CL, Drainoni ML. Antibiotics for respiratory tract infections: a comparison of prescribing in an outpatient setting. Infect Control Hosp Epidemiol. 2015;36(2):153-9. https:\/\/doi.org\/10.1017\/ice.2014.21.","journal-title":"Infect Control Hosp Epidemiol."},{"issue":"2","key":"10930_CR5","doi-asserted-by":"publisher","first-page":"e180243","DOI":"10.1001\/jamanetworkopen.2018.0243","volume":"1","author":"FP Havers","year":"2018","unstructured":"Havers FP, Hicks LA, Chung JR, et al. Outpatient Antibiotic Prescribing for Acute Respiratory Infections During Influenza Seasons. JAMA Netw Open. 2018;1(2):e180243. https:\/\/doi.org\/10.1001\/jamanetworkopen.2018.0243.","journal-title":"JAMA Netw Open."},{"issue":"8","key":"10930_CR6","doi-asserted-by":"publisher","first-page":"e72","DOI":"10.1093\/cid\/cir1043","volume":"54","author":"AW Chow","year":"2012","unstructured":"Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72-e112. https:\/\/doi.org\/10.1093\/cid\/cir1043.","journal-title":"Clin Infect Dis."},{"key":"10930_CR7","doi-asserted-by":"publisher","unstructured":"Vazquez Deida AA, Bizune DJ, Kim C, et al. Opportunities to Improve Antibiotic Prescribing for Adults With Acute Sinusitis, United States, 2016\u20132020. Open Forum Infect Dis. 2024;11(8):ofae420. https:\/\/doi.org\/10.1093\/ofid\/ofae420.","DOI":"10.1093\/ofid\/ofae420"},{"issue":"11","key":"10930_CR8","doi-asserted-by":"publisher","first-page":"2018","DOI":"10.1002\/alr.23167","volume":"13","author":"JP Shah","year":"2023","unstructured":"Shah JP, Youn GM, Wei EX, Patel ZM. Disparities in access to health care in adults with sinusitis in the United States. Int Forum Allergy Rhinol. 2023;13(11):2018-2029. https:\/\/doi.org\/10.1002\/alr.23167.","journal-title":"Int Forum Allergy Rhinol."},{"issue":"3","key":"10930_CR9","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1177\/19458924211056294","volume":"36","author":"C Ma","year":"2022","unstructured":"Ma C, Mehta NK, Nguyen SA, Gudis DA, Miglani A, Schlosser RJ. Demographic Variation in Chronic Rhinosinusitis by Subtype and Region: A Systematic Review. Am J Rhinol Allergy. 2022;36(3):367-377. https:\/\/doi.org\/10.1177\/19458924211056294.","journal-title":"Am J Rhinol Allergy."},{"issue":"4","key":"10930_CR10","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1542\/peds.2012-2500","volume":"131","author":"JS Gerber","year":"2013","unstructured":"Gerber JS, Prasad PA, Localio AR, et al. Racial differences in antibiotic prescribing by primary care pediatricians. Pediatrics. 2013;131(4):677-84. https:\/\/doi.org\/10.1542\/peds.2012-2500.","journal-title":"Pediatrics."},{"issue":"3","key":"10930_CR11","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1542\/peds.99.3.318","volume":"99","author":"JL Paradise","year":"1997","unstructured":"Paradise JL, Rockette HE, Colborn DK, et al. Otitis media in 2253 Pittsburgh-area infants: prevalence and risk factors during the first two years of life. Pediatrics. 1997;99(3):318-33. https:\/\/doi.org\/10.1542\/peds.99.3.318.","journal-title":"Pediatrics."},{"key":"10930_CR12","doi-asserted-by":"publisher","unstructured":"Jaffe IS, Jaehne AK, Quackenbush E, et al. Comparing the Diagnostic Accuracy of Clinician Judgment to a Novel Host Response Diagnostic for Acute Respiratory Illness. Open Forum Infect Dis. 2021;8(12):ofab564. https:\/\/doi.org\/10.1093\/ofid\/ofab564.","DOI":"10.1093\/ofid\/ofab564"},{"issue":"10","key":"10930_CR13","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1002\/alr.22165","volume":"8","author":"CC Xiao","year":"2018","unstructured":"Xiao CC, Anderson M, Harless LD, Liang J. Shortcomings in the diagnosis of chronic rhinosinusitis: evaluating diagnosis by otolaryngologists and primary care physicians. Int Forum Allergy Rhinol. 2018;8(10):1107-1113. https:\/\/doi.org\/10.1002\/alr.22165.","journal-title":"Int Forum Allergy Rhinol."},{"issue":"6","key":"10930_CR14","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1007\/s11606-018-4823-x","volume":"34","author":"KA Martinez","year":"2019","unstructured":"Martinez KA, Rood M, Rothberg MB. Coding Bias in Respiratory Tract Infections May Obscure Inappropriate Antibiotic Use. J Gen Intern Med. 2019;34(6):806-808. https:\/\/doi.org\/10.1007\/s11606-018-4823-x.","journal-title":"J Gen Intern Med."},{"issue":"4","key":"10930_CR15","doi-asserted-by":"publisher","first-page":"275","DOI":"10.7326\/M18-2042","volume":"170","author":"KA Martinez","year":"2019","unstructured":"Martinez KA, Rood M, Jhangiani N, Boissy A, Rothberg MB. Antibiotic Prescribing for Respiratory Tract Infections and Encounter Length: An Observational Study of Telemedicine. Ann Intern Med. 2019;170(4):275-277. https:\/\/doi.org\/10.7326\/M18-2042.","journal-title":"Ann Intern Med."},{"key":"10930_CR16","doi-asserted-by":"publisher","first-page":"114007","DOI":"10.1016\/j.socscimed.2021.114007","volume":"290","author":"T Stivers","year":"2021","unstructured":"Stivers T, Timmermans S. Arriving at no: Patient pressure to prescribe antibiotics and physicians' responses. Soc Sci Med. 2021;290:114007. https:\/\/doi.org\/10.1016\/j.socscimed.2021.114007.","journal-title":"Soc Sci Med."},{"key":"10930_CR17","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1016\/j.ssmph.2018.04.003","volume":"4","author":"C Adams","year":"2018","unstructured":"Adams C, Chatterjee A, Harder BM, Mathias LH. Beyond unequal access: Acculturation, race, and resistance to pharmaceuticalization in the United States. 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JAMA Netw Open. 2025;8(4):e254763. https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.4763.","journal-title":"JAMA Netw Open."}],"container-title":["Journal of General Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11606-026-10930-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11606-026-10930-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11606-026-10930-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:36:30Z","timestamp":1792042590000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11606-026-10930-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":18,"alternative-id":["10930"],"URL":"https:\/\/doi.org\/10.1007\/s11606-026-10930-5","relation":{},"ISSN":["0884-8734","1525-1497"],"issn-type":[{"value":"0884-8734","type":"print"},{"value":"1525-1497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,14]]},"assertion":[{"value":"12 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 October 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was deemed exempt by Cleveland Clinic\u2019s Institutional Review Board.","order":1,"name":"Ethics","label":"Human Ethics and Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no conflicts to declare.","order":2,"name":"Ethics","label":"Conflict of interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}