Authors: Oxlade, O.¹; Schwartzman, K.²; Behr, M.A.³; Benedetti, A.⁴; Pai, M.⁴; Heymann, J.⁵; Menzies, D.⁴

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 10, October 2009 , pp. 1238-1246(9)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

BACKGROUND: Many international organizations are advocating for new funds for tuberculosis (TB) specific interventions. Although this approach should help reduce TB incidence, improvements in population health may also be important. We have analyzed the association between changes in population health and health service indicators, and concomitant changes in TB incidence between 1990 and 2005.

METHODS: Country level data on population health and health services, economic and epidemiologic indicators were obtained for 165 countries. Regression methods were used to estimate the association of changes in potential predictors with changes in TB incidence.

RESULTS: Improvements in population health and health services are associated with improvements in TB outcomes. In adjusted analyses, each 1 year increase in life expectancy was associated with a 7.8/100 000 decline in TB incidence. A 1/1000 decrease in mortality rate in children aged <5 years and a 1% increase in measles vaccination coverage (serving as a general health services indicator) was associated with approximately a 1/100 000 decrease in TB incidence. In countries with a lower prevalence of human immunodeficiency virus (HIV) infection, a 1% increase in TB treatment success rate was also associated with a 1/100 000 decrease in incidence.

CONCLUSION: Investment in improving population health and health services may be as important as targeted strategies for controlling TB.

Keywords: tuberculosis; disease trends; population health; social determinants

Document Type: Regular paper

Affiliations: 1: Respiratory Epidemiology & Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada 2: Respiratory Epidemiology & Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada; and Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada 3: Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada 4: Respiratory Epidemiology & Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada; and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada 5: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; and Institute of Health and Social Policy, McGill University, Montreal, Quebec, Canada

Publication date: 2009-10-01

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• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

  Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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