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Four decades of pulmonary tuberculosis in deceased South African miners: trends and determinants.
Occup Environ Med. 2018 11; 75(11):767-775.OE

Abstract

OBJECTIVE

We investigated trends and determinants of pulmonary tuberculosis (PTB) in deceased South African miners.

METHODS

Statutory autopsies are performed on miners for occupational lung disease compensation, irrespective of cause of death. Data were extracted from the PATHAUT (Pathology Automation System) autopsy database. PTB trends were analysed and explanatory variables (year of autopsy, age at death, gold employment duration, silicosis and HIV) were evaluated using binary logistic regression modelling. Analyses were stratified by population group because of racial differences in socioeconomic status, employment patterns and access to facilities for autopsies. The analyses were segmented to represent the pre-HIV (1975-1989), rapid HIV spread (1990-2004) and antiretroviral therapy (2005-2014) periods.

RESULTS

The proportions of men with PTB at autopsy increased from 4.62% in 1975 to 27.18% in 2014 in black miners, and from 2.07% to 5.19% in white miners, with peaks in 2007 (43.12% and 9.51%, respectively). The magnitude and significance of adjusted ORs of determinants differed by population group and calendar period. PTB was largely associated with silicosis, increasing gold employment duration and year of autopsy (a surrogate for unmeasured confounders, such as unknown HIV status and tuberculosis transmission).

CONCLUSIONS

Changes in PTB time trends and determinants reflect the complex social and political environment in which mining occurs. Silica dust reduction remains a key intervention for tuberculosis reduction, together with tuberculosis and HIV treatment and management. The autopsy data provide reliable information to monitor progress towards the achievement of industry and national targets to reduce tuberculosis.

Authors+Show Affiliations

School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.Division of Critical Care, Charlotte Maxeke Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29934377

Citation

Ndlovu, Ntombizodwa, et al. "Four Decades of Pulmonary Tuberculosis in Deceased South African Miners: Trends and Determinants." Occupational and Environmental Medicine, vol. 75, no. 11, 2018, pp. 767-775.
Ndlovu N, Musenge E, Park SK, et al. Four decades of pulmonary tuberculosis in deceased South African miners: trends and determinants. Occup Environ Med. 2018;75(11):767-775.
Ndlovu, N., Musenge, E., Park, S. K., Girdler-Brown, B., Richards, G., & Murray, J. (2018). Four decades of pulmonary tuberculosis in deceased South African miners: trends and determinants. Occupational and Environmental Medicine, 75(11), 767-775. https://doi.org/10.1136/oemed-2017-104806
Ndlovu N, et al. Four Decades of Pulmonary Tuberculosis in Deceased South African Miners: Trends and Determinants. Occup Environ Med. 2018;75(11):767-775. PubMed PMID: 29934377.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Four decades of pulmonary tuberculosis in deceased South African miners: trends and determinants. AU - Ndlovu,Ntombizodwa, AU - Musenge,Eustasius, AU - Park,Sung Kyun, AU - Girdler-Brown,Brendan, AU - Richards,Guy, AU - Murray,Jill, Y1 - 2018/06/22/ PY - 2017/10/10/received PY - 2018/04/17/revised PY - 2018/05/25/accepted PY - 2018/6/24/pubmed PY - 2019/7/28/medline PY - 2018/6/24/entrez KW - HIV KW - autopsy KW - compensation KW - pathaut KW - silicosis SP - 767 EP - 775 JF - Occupational and environmental medicine JO - Occup Environ Med VL - 75 IS - 11 N2 - OBJECTIVE: We investigated trends and determinants of pulmonary tuberculosis (PTB) in deceased South African miners. METHODS: Statutory autopsies are performed on miners for occupational lung disease compensation, irrespective of cause of death. Data were extracted from the PATHAUT (Pathology Automation System) autopsy database. PTB trends were analysed and explanatory variables (year of autopsy, age at death, gold employment duration, silicosis and HIV) were evaluated using binary logistic regression modelling. Analyses were stratified by population group because of racial differences in socioeconomic status, employment patterns and access to facilities for autopsies. The analyses were segmented to represent the pre-HIV (1975-1989), rapid HIV spread (1990-2004) and antiretroviral therapy (2005-2014) periods. RESULTS: The proportions of men with PTB at autopsy increased from 4.62% in 1975 to 27.18% in 2014 in black miners, and from 2.07% to 5.19% in white miners, with peaks in 2007 (43.12% and 9.51%, respectively). The magnitude and significance of adjusted ORs of determinants differed by population group and calendar period. PTB was largely associated with silicosis, increasing gold employment duration and year of autopsy (a surrogate for unmeasured confounders, such as unknown HIV status and tuberculosis transmission). CONCLUSIONS: Changes in PTB time trends and determinants reflect the complex social and political environment in which mining occurs. Silica dust reduction remains a key intervention for tuberculosis reduction, together with tuberculosis and HIV treatment and management. The autopsy data provide reliable information to monitor progress towards the achievement of industry and national targets to reduce tuberculosis. SN - 1470-7926 UR - https://www.unboundmedicine.com/medline/citation/29934377/Four_decades_of_pulmonary_tuberculosis_in_deceased_South_African_miners:_trends_and_determinants_ L2 - http://oem.bmj.com/cgi/pmidlookup?view=long&pmid=29934377 DB - PRIME DP - Unbound Medicine ER -