A new study has found that the major predictors of antimicrobial resistance could be socioeconomic inequality and living conditions, such as overcrowding and access to sanitation, and not just antibiotic consumption.

Researchers, including those from King's College London, said that reducing antibiotic consumption alone will be insufficient and that governments should prioritise structural public health interventions, including improving nutritional status, reducing overcrowding and strengthening health equity in high-risk areas.

Antimicrobial resistance (AMR), which occurs when a microbe develops an immunity against the very drugs designed to kill it, is projected to claim more than 39 million lives over the next 25 years, according to estimates published in The Lancet journal in September 2025.

Senior author Tania Dottorini, professor of artificial intelligence in science at King's College London, said, "Our research uses a multi-scale, multi-modal approach that has never been applied in this way before. By identifying which resistance traits are increasing, where they are spreading, and what is driving them, we can better target surveillance, policy and interventions towards the threats that are most likely to impact global health in the future." "Reducing antibiotic use alone won't be enough. Tackling AMR requires structural interventions on inequality, sanitation, nutrition and health equity alongside stewardship. We believe that our findings provide a roadmap for targeted AMR interventions," Dottorini said.

The researchers analysed more than 45,000 genomes collected from across 127 countries of 16 bacterial species, which the World Health Organization (WHO) has identified as critical priority pathogens.

The species, including Klebsiella, Acinetobacter and Escherichia coli, are associated with high mortality and limited treatment options. Resistance genes in the bacterial species linked to antibiotic resistance were identified.

The study, published in the journal Cell Genomics, then looked at more than 1,000 environmental, health and socioeconomic indicators, such as poverty, climate and healthcare trends, to understand how the global factors may change in the future.

The global trends were then linked with resistance genes to identify which characteristics of antimicrobial resistance are most strongly associated with future environmental and socioeconomic changes.

The researchers were thus able to forecast the resistance threats most likely to grow by 2050, specifically 210 pathogen-specific traits and key socioeconomic indicators that could drive the threats.

"At the core of our results, 210 AMR traits were identified possessing the strongest correlation to AMR resistance, a demonstrated increase of prevalence globally over the next 25 years, and featuring strong correlation with several social, economic, and environmental indicators, with mortality being the strongest, followed by social determinants of health, including socioeconomic disparities and antibiotic consumption," the authors wrote.

"Interestingly, while mortality is correlated with projection trends of most AMR traits, socioeconomic disparities emerge as the main associations for the 32 AMR traits identified as critical threats. We believe our work provides actionable insights into tackling AMR challenges," they said.

The team added that the study "offers a new, actionable layer to guide national AMR strategies".