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Socio-economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa.
Trop Med Int Health. 2018 04; 23(4):375-390.TM

Abstract

OBJECTIVE

To describe the associations between socio-economic position and prevalent tuberculosis in the 2010 ZAMSTAR Tuberculosis Prevalence Survey, one of the first large tuberculosis prevalence surveys in Southern Africa in the HIV era.

METHODS

The main analyses used data on 34 446 individuals in Zambia and 30 017 individuals in South Africa with evaluable tuberculosis culture results. Logistic regression was used to estimate adjusted odds ratios for prevalent TB by two measures of socio-economic position: household wealth, derived from data on assets using principal components analysis, and individual educational attainment. Mediation analysis was used to evaluate potential mechanisms for the observed social gradients.

RESULTS

The quartile with highest household wealth index in Zambia and South Africa had, respectively, 0.55 (95% CI 0.33-0.92) times and 0.70 (95% CI 0.54-0.93) times the adjusted odds of prevalent TB of the bottom quartile. College or university-educated individuals in Zambia and South Africa had, respectively, 0.25 (95% CI 0.12-0.54) and 0.42 (95% CI 0.25-0.70) times the adjusted odds of prevalent TB of individuals who had received only primary education. We found little evidence that these associations were mediated via several key proximal risk factors for TB, including HIV status.

CONCLUSION

These data suggest that social determinants of TB remain important even in the context of generalised HIV epidemics.

Authors+Show Affiliations

Institute for Global Health, University College London, London, UK.ZAMBART, School of Medicine, University of Zambia, Lusaka, Zambia. Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.ZAMBART, School of Medicine, University of Zambia, Lusaka, Zambia.Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29432669

Citation

Yates, Tom A., et al. "Socio-economic Gradients in Prevalent Tuberculosis in Zambia and the Western Cape of South Africa." Tropical Medicine & International Health : TM & IH, vol. 23, no. 4, 2018, pp. 375-390.
Yates TA, Ayles H, Leacy FP, et al. Socio-economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa. Trop Med Int Health. 2018;23(4):375-390.
Yates, T. A., Ayles, H., Leacy, F. P., Schaap, A., Boccia, D., Beyers, N., Godfrey-Faussett, P., & Floyd, S. (2018). Socio-economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa. Tropical Medicine & International Health : TM & IH, 23(4), 375-390. https://doi.org/10.1111/tmi.13038
Yates TA, et al. Socio-economic Gradients in Prevalent Tuberculosis in Zambia and the Western Cape of South Africa. Trop Med Int Health. 2018;23(4):375-390. PubMed PMID: 29432669.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Socio-economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa. AU - Yates,Tom A, AU - Ayles,Helen, AU - Leacy,Finbarr P, AU - Schaap,A, AU - Boccia,Delia, AU - Beyers,Nulda, AU - Godfrey-Faussett,Peter, AU - Floyd,Sian, Y1 - 2018/03/24/ PY - 2018/2/13/pubmed PY - 2019/1/3/medline PY - 2018/2/13/entrez KW - Afrique du Sud KW - HIV KW - South Africa KW - VIH KW - Zambia KW - Zambie KW - social epidemiology KW - tuberculose KW - tuberculosis KW - épidémiologie sociale SP - 375 EP - 390 JF - Tropical medicine & international health : TM & IH JO - Trop. Med. Int. Health VL - 23 IS - 4 N2 - OBJECTIVE: To describe the associations between socio-economic position and prevalent tuberculosis in the 2010 ZAMSTAR Tuberculosis Prevalence Survey, one of the first large tuberculosis prevalence surveys in Southern Africa in the HIV era. METHODS: The main analyses used data on 34 446 individuals in Zambia and 30 017 individuals in South Africa with evaluable tuberculosis culture results. Logistic regression was used to estimate adjusted odds ratios for prevalent TB by two measures of socio-economic position: household wealth, derived from data on assets using principal components analysis, and individual educational attainment. Mediation analysis was used to evaluate potential mechanisms for the observed social gradients. RESULTS: The quartile with highest household wealth index in Zambia and South Africa had, respectively, 0.55 (95% CI 0.33-0.92) times and 0.70 (95% CI 0.54-0.93) times the adjusted odds of prevalent TB of the bottom quartile. College or university-educated individuals in Zambia and South Africa had, respectively, 0.25 (95% CI 0.12-0.54) and 0.42 (95% CI 0.25-0.70) times the adjusted odds of prevalent TB of individuals who had received only primary education. We found little evidence that these associations were mediated via several key proximal risk factors for TB, including HIV status. CONCLUSION: These data suggest that social determinants of TB remain important even in the context of generalised HIV epidemics. SN - 1365-3156 UR - https://www.unboundmedicine.com/medline/citation/29432669/Socio_economic_gradients_in_prevalent_tuberculosis_in_Zambia_and_the_Western_Cape_of_South_Africa_ L2 - https://doi.org/10.1111/tmi.13038 DB - PRIME DP - Unbound Medicine ER -