Impact of socio-economic inequities on tuberculosis in a Southern European city: what is the effect of the recession?

Abstract

Introduction: Economic crises affect the population's health, especially among the most deprived. The increase in health inequalities in this recession may have influenced the incidence of tuberculosis (TB). We analyzed the effect of socioeconomic inequities and the recession on the incidence of TB. Methods: We conducted a population-based incidence study of TB cases in Barcelona, Spain, who started treatment between 2003 and 2015. A multilevel interrupted time series analysis was done to analyze differences in incidence trends between the pre-recession (until 2008) and recession periods. Results: We observed differences in TB incidence according to deprivation and immigration status. TB incidence among most deprived neighborhoods was 2.72 times higher than least deprived. Compared to natives, incidence was 9 times higher among those born in Africa, and 6 times higher among those born in Asia and Oceania. The previous decreasing trend in incidence (4%) was accentuated during the recession (7%). Conclusions: The incidence of TB decreased during the recession, probably due to a reduction of new immigrants and the TB programme. However, incidence is highly unequal between districts with different levels of deprivation, and between foreign-born from different geographical regions. Social measures are important for reducing inequalities and TB incidence in Barcelona.

Epidemiology: the current burden of tuberculosis and its determinants

“…These include individual health-related risk factors (such as HIV, diabetes and smoking) and broader socioeconomic determinants (such as poverty, working and living conditions, and lack of food security) [45]. Evidence of the role of socioeconomic risk factors in TB epidemiology continues to grow [46][47][48][49][50], with an impact on all stages, from risk of exposure to clinical outcome [51].…”

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“…Herrialde garatuei dagokienez, oro har, intzidentzia altuagoak Jatorrizko artikuluak Osagaiz -2019 -3. bolumena -2. zk. -57 antzematen dira atzerrian jaiotako pertsonetan edota maila sozioekonomiko baxuagoa dutenetan (11)(12)(13)(14).…”

Towards TB elimination: how are macro-level factors perceived and addressed in policy initiatives in a high burden country?

“…Tuberculosis (TB) is a preventable and curable condition that remains among the top ten causes of death worldwide, killing about 1.8 million people each year [1]. It is widely agreed that TB rates reflect the economic and socio-cultural conditions within a country, as well as other macro-level or structural determinants of health [2][3][4]. As a disease of poverty, TB is driven by structural or upstream forces and disproportionally affects the economically disadvantaged and marginalized in society, with highly uneven distribution globally.…”