F. Elender et al., TUBERCULOSIS MORTALITY IN ENGLAND AND WALES DURING 1982-1992 - ITS ASSOCIATION WITH POVERTY, ETHNICITY AND AIDS, Social science & medicine, 46(6), 1998, pp. 673-681
Citations number
51
Categorie Soggetti
Social Sciences, Biomedical","Public, Environmental & Occupation Heath
This paper seeks to establish the strength of association between cont
emporary tuberculosis (TB) in England and Wales and several potential
aetiological factors. It presents an ecological analysis of standardis
ed annual TB mortality rates for the 403 local authority districts bet
ween 1982 and 1992, disaggregated by age and sex. Social, demographic
and ethnicity measures from the 1981 and 1991 censuses and standardise
d annual AIDS-related mortality rates for young men are used to calcul
ate Poisson regression models. A strong association was found between
all TB mortality groups and overcrowding at the household level. For N
omen, no other measures improved the explanatory power of the models.
In multiple regressions, both poverty and AIDS-related mortality expla
ined additional variation in the model for younger men. The link betwe
en ethnicity and tuberculosis notifications was not reflected in this
analysis of mortality. For all groups no evidence of a positive relati
onship with ethnicity was found, once overcrowding had been accounted
for. The significance of household as opposed to district level crowdi
ng suggests that prolonged contact is required for disease transmissio
n. Regression analysis indicates that it is the overcrowding and pover
ty among ethnic populations that is significant for their tuberculosis
mortality. The fact that the relationship between AIDS and TB is conf
ined to the group most typical of AIDS patients provides evidence that
AIDS has little influence on the level of tuberculosis mortality in t
he wider population. Explanations for the observed relationship includ
e preferential certification, migration for treatment and shortcomings
in health care provision. (C) 1998 Elsevier Science Ltd. All rights r
eserved.