Investigating urban–rural disparities in tuberculosis treatment outcome in England and Wales

Abstract

SUMMARYThe purpose of this study was to compare the occurrence of tuberculosis (TB) and the outcome of treatment between TB patients living in urban and rural areas. Cases of TB reported from 2001 to 2003 in England and Wales were assigned to a rural or urban area classification. The outcome of interest, non-completion of treatment, was investigated to determine the odds ratio for urban vs. rural residence. The effects of age, sex, ethnicity, place of birth, time since arrival in the United Kingdom, disease site, isoniazid resistance and previous diagnosis were adjusted for by multivariable logistic regression. Crude odds ratios showed a significantly higher level of treatment non-completion in rural areas. These results became non-significant (OR 1 . 02, 95 % CI 0 . 83-1 . 26, P=0 . 82) after adjusting for the confounding effects of ethnic group and age. In England and Wales residence in a rural location is not an independent determinant of TB treatment outcome failure.

Role of casual contacts in the recent transmission of tuberculosis in settings with high disease burden

“…China, where on average 67% of the population belonged to an agricultural population. A recent nationwide survey showed that the prevalence of TB was relatively higher in rural areas than in urban areas, which is not the case in low-incidence countries [19]. The surprisingly low clustering found in this study, in contrast to places such as South Africa, which has co-infection of TB and human immunodeficiency virus (HIV) and explosive outbreaks (i.e.…”

“…We used a combination of molecular methods and epidemiological data to determine the genetic diversity of circulating Mtb strains, and provide the estimates of recent transmission and risk factors for clustering among pulmonary TB patients in rural China, where on average 67% of the population belonged to an agricultural population. A recent nationwide survey showed that the prevalence of TB was relatively higher in rural areas than in urban areas, which is not the case in low‐incidence countries . The surprisingly low clustering found in this study, in contrast to places such as South Africa, which has co‐infection of TB and human immunodeficiency virus (HIV) and explosive outbreaks (i.e.…”

Urban-Rural Disparities in Treatment Outcomes Among Recurrent TB Cases in Zambia

“…Health care service delivery is better in urban populations because health facilities are easy to reach whereas rural patients must travel long distances. [10,11] Additionally, urban settings have more skilled health care providers with more clinical experience in the management of TB and HIV and access to better diagnostics. In contrast, most TB patients in urban settings are from deprived communities and social disadvantages such as slums which may contribute to poorer TB treatment outcomes.…”

“…In contrast, most TB patients in urban settings are from deprived communities and social disadvantages such as slums which may contribute to poorer TB treatment outcomes. [10] We examined the prevalence of recurrent TB among TB cases notified to the National TB Program (NTP) in southern province of Zambia. We assessed for risk factors associated with death, loss to follow up and failure among recurrent TB patients accessing treatment at health facilities in rural and urban settings.…”

Authors' reply

“…If every person with, for example, a cough lasting 3 weeks is investigated for tuberculosis, this will result in significant unnecessary investigation, especially in primary care. With <9000 cases in a population of 60 million, the majority of whom are resident in urban areas,3 the average general practitioner in a rural area in the UK may not see a single case of tuberculosis in several years.…”