Factors associated with the high tuberculosis case rate in an urban area
Abstract:SETTING: The Rotterdam region, the Netherlands, 1995–2006.
OBJECTIVE: To identify factors associated with the high tuberculosis (TB) case rate in an urban area.
DESIGN: Municipalities were divided into urban and semi-urban/rural municipalities. We compared the characteristics of TB cases and stratified case rates according to age group, immigrant status and place and time of infection between the two areas.
RESULTS: The TB case rate in urban municipalities was 3.8-fold higher than in semi-urban/rural municipalities. After stratification for country of birth, the rate ratios were lower (1.7 for immigrants and 2.8 for non-immigrants). Immigrants had most frequently acquired their infection abroad (47% of urban and 62% of semi-urban/rural immigrant cases). In 40% of urban cases and 27% of semi-urban/rural cases, the infection was recently acquired in the Netherlands, translating into a 5.7-fold higher recent transmission case rate for the urban population.
CONCLUSIONS: The high urban TB case rate was related to the high proportion of urban immigrants who frequently reactivated an infection acquired abroad. Recent transmission also contributed to a substantial part of the TB caseload in urban municipalities among both urban immigrants and non-immigrants. The authors propose a package of targeted interventions to address the identified factors associated with the high urban TB case rate.
Document Type: Regular Paper
Affiliations: 1: Department of Tuberculosis Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands; Department of Public Health, Erasmus Medical Centre, University Medical Center Rotterdam, Rotterdam, The Netherlands 2: Department of Tuberculosis Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands 3: National Mycobacteria Reference Laboratory, National Institute of Public Health and the Environment, Bilthoven, The Netherlands; and KNCV Tuberculosis Foundation, The Hague, The Netherlands 4: Department of Public Health, Erasmus Medical Centre, University Medical Center Rotterdam, Rotterdam, The Netherlands; and Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
Publication date: 2010-07-01
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