Tuberculosis Mortality by Occupation in South Africa, 2011–2015

Abstract

Work-related tuberculosis (TB) remains a public health concern in low- and middle-income countries. The use of vital registration data for monitoring TB deaths by occupation has been unexplored in South Africa. Using underlying cause of death and occupation data for 2011 to 2015 from Statistics South Africa, age-standardised mortality rates (ASMRs) were calculated for all persons of working age (15 to 64 years) by the direct method using the World Health Organization (WHO) standard population. Multivariate logistic regression analysis was performed to calculate mortality odds ratios (MORs) for occupation groups, adjusting for age, sex, year of death, province of death, and smoking status. Of the 221,058 deaths recorded with occupation data, 13% were due to TB. ASMR for TB mortality decreased from 165.9 to 88.8 per 100,000 population from 2011 to 2015. An increased risk of death by TB was observed among elementary occupations: agricultural labourers (MORadj = 3.58, 95% Confidence Interval (CI) 2.96–4.32), cleaners (MORadj = 3.44, 95% CI 2.91–4.09), and refuse workers (MORadj = 3.41, 95% CI 2.88–4.03); among workers exposed to silica dust (MORadj = 3.37, 95% CI 2.83–4.02); and among skilled agricultural workers (MORadj = 3.31, 95% CI 2.65–4.19). High-risk TB occupations can be identified from mortality data. Therefore, TB prevention and treatment policies should be prioritised in these occupations.

Young Adult Age-Period-Cohort Analysis of HIV and TB Mortality in South Africa: 1997-2015

“…Our study showed that the age group 33-35 was more at risk of TB mortality than all other age groups, which correspond to Kootbodien et.al 25 findings. We found a decline in TB death rates in South Africa from 2007 to 2015, which is in line with the 68.8% to 77.2% global reduction in TB mortality from 2007 to 2014 respectively.…”

“…Estimated relative risk of TB and HIV mortality rates using the APC analysis found similar results as official statistics, global TB and HIV report, and other similar research findings in South Africa have shown about age effects 1,2,6,24,25 . However, our estimated RRs for HIVrelated mortality differed from the official statistics of South Africa in terms of period effects.…”

Occupational Tuberculosis Among Laboratory Workers in South Africa: Applying a Surveillance System to Strengthen Prevention and Control

“…Despite the United Nations' 2018 High Level meeting on the "Fight Against TB" that recognized healthcare workers as a high-risk group, accurate and timely information on occupational exposures remains limited, which puts these workers in jeopardy. Numerous studies have concluded that health workers are subject to increased rates of infection which are significantly higher than the general population, with particular concern for low-and middle-income settings in high tuberculosis (TB) incidence countries [1][2][3][4][5][6]. However, there is a lack of research investigating the differentiation in exposure and disease between the subcategories of healthcare workers, such as laboratory workers, who may have a significantly different education and interaction with healthcare delivery.…”

“…Continued outbreaks and TB transmissions associated with frequent unprotected exposure to TB patients or bacteria cause significant concern in the healthcare sector, as outbreaks cause increased stress of workers, increased absences from work and additional financial burdens on already limited budgets [10]. The persistence of TB as a notable occupational hazard is further aggravated by weak occupational health programmes, limited healthcare resources, and reluctance to disclose TB diagnosis due to stigma [6,7]. However, the extent and nature of the problem remains obscured in the absence of surveillance.…”

“…There is an urgent need for effective surveillance programmes for occupational TB that have the ability to evaluate factors of exposure specific to the occupational groups within the healthcare system. Such a surveillance system could provide a better understanding of the distribution of TB and the factors that aid or hinder transmission in a timely and comprehensive manner, as well as be used to enhance prevention strategies and support future policy and procedures [5,6,[11][12][13]. Interventions informed by surveillance evidence allow for prevention, early diagnosis, education and training of healthcare workers, and may be effective in decreasing prevalence in a notably vulnerable group [1].…”