Neighborhood poverty and the resurgence of tuberculosis in New York City, 1984-1992

Objectives. The resurgence of tuberculosis (TB) in New York City has been a ttributed to AIDS and immigration; however the role of poverty in the epide mic is unclear. We assessed the relation between neighborhood poverty and T B at the height of the epidemic and longitudinally from 1984 through 1992. Methods. Census block groups were used as proxies for neighborhoods. For ea ch neighborhood, we calculated TB and AIDS incidence in 1984 and 1992 with data from the Bureaus of Tuberculosis Control and AIDS Surveillance and obt ained poverty rates from the census. Results. For 1992, 3343 TB cases were mapped to 5482 neighborhoods, yieldin g a mean incidence of 46.5 per 100000. Neighborhood poverty was associated with TB (relative risk = 1.33; 95% confidence interval = 1.30, 1.36 per 10% increase in poverty). This association persisted after adjustment for AIDS , proportion foreign-born, and race/ethnicity. Neighborhoods with declining income from 1980 to 1990 had larger increases in TB incidence than did nei ghborhoods with increasing income. Conclusions. Leading up to and at the height of the TB epidemic in New York City, neighborhood poverty was strongly associated with TB incidence. Publ ic health interventions should target impoverished areas.