Tuberculosis and Poverty: Why Are the Poor at Greater Risk in India?

Abstract

BackgroundAlthough poverty is widely recognized as an important risk factor for tuberculosis (TB) disease, the specific proximal risk factors that mediate this association are less clear. The objective of our study was to investigate the mechanisms by which poverty increases the risk of TB.MethodsUsing individual level data from 198,754 people from the 2006 Demographic Health Survey (DHS) for India, we assessed self-reported TB status, TB determinants and household socioeconomic status. We used these data to calculate the population attributable fractions (PAF) for each key TB risk factor based on the prevalence of determinants and estimates of the effect of these risk factors derived from published sources. We conducted a mediation analysis using principal components analysis (PCA) and regression to demonstrate how the association between poverty and TB prevalence is mediated.ResultsThe prevalence of self-reported TB in the 2006 DHS for India was 545 per 100,000 and ranged from 201 in the highest quintile to 1100 in the lowest quintile. Among those in the poorest population, the PAFs for low body mass index (BMI) and indoor air pollution were 34.2% and 28.5% respectively. The PCA analysis also showed that low BMI had the strongest mediating effect on the association between poverty and prevalent TB (12%, p = 0.019).ConclusionTB control strategies should be targeted to the poorest populations that are most at risk, and should address the most important determinants of disease—specifically low BMI and indoor air pollution.

Old World tuberculosis: Evidence from human remains with a review of current research and future prospects

“…For example, while many of the disadvantages of transitioning to agriculture apply for this period in Europe, added to these are increases in inequality leading to poverty, and a rise in mobility of people. Tuberculosis is classed as a disease of poverty today 22 and a poor diet can compromise immune system strength and make people more susceptible to contracting TB. Furthermore, a rise in poor air quality both indoors and outdoors occurred at this time, which can predispose the lungs to being more susceptible to attack by tuberculosis 23 .…”

Reply

“…However, in recent studies from different parts of the world, 25 (OH) D3 deficiencies were reported in both adults 1 and children 2 with CKD. The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the management of CKD-MBD recommended that 25 (OH) D3 levels should be monitored and if low, ergo-or cholecalciferol supplements should be prescribed.…”

“…2 Certainly the results in adult patients may not reflect the specifications of children, but some extrapolation of data can be made. The control group of the present study had similar results.…”

Fighting Tuberculosis: From China to America

“…The initial symptoms of TB patients, such as cough, low fever, lack of appetite, and fatigue, are often trivial and easy to ignore. TB is associated with poverty and mostly affects the poorest of the poor [4]. The disease also imposes financial burdens on patients and their families, either directly due to the cost of the diagnosis and treatment or indirectly due to the income loss [5].…”