TY - JOUR
T1 - Neighbourhood risk factors of recurrent tuberculosis in Cape Town
T2 - a cohort study using geocoded notification data
AU - Molemans, M.
AU - Van Leth, F.
AU - Mckelly, D.H.
AU - Wood, R.
AU - Hermans, S.
N1 - Publisher Copyright: ©
PY - 2022/11/15
Y1 - 2022/11/15
N2 - Background Individuals with a history of tuberculosis (TB) disease are at higher risk of developing a subsequent episode than those without. Considering the role of social and environmental factors in tuberculosis, we assessed neighbourhood-level risk factors associated with recurrent tuberculosis in Cape Town, South Africa. Methods This cohort consisted of patients who completed treatment for their first drug-sensitive TB episode between 2003 and 2015. Addresses were geocoded at neighbourhood level. Data on neighbourhood-level factors were obtained from the Census 2011 (household size, population density) and the City of Cape Town (Socio-Economic Index). Neighbourhood-level TB burden was calculated annually by dividing the number of notified TB episodes by the population in that neighbourhood. Multilevel survival analysis was performed with the outcome recurrent TB, defined as a second episode of TB, and controlling for individual-level risk factors (age, gender and time since first episode in years). Follow-up ended at the second episode, or on 31 December 2015, whichever came first. Results The study included 173 421 patients from 700 neighbourhoods. Higher Socio-Economic Index was associated with a lower risk of recurrence compared with average Socio-Economic Index. An increased risk was found for higher household size and TB burden, with an increase of 20% for every additional person in mean household size and 10% for every additional TB episode/100 inhabitants. No association was found with population density. Conclusion Recurrent TB was associated with increased household size and TB burden at neighbourhood level. These findings could be used to target TB screening activities.
AB - Background Individuals with a history of tuberculosis (TB) disease are at higher risk of developing a subsequent episode than those without. Considering the role of social and environmental factors in tuberculosis, we assessed neighbourhood-level risk factors associated with recurrent tuberculosis in Cape Town, South Africa. Methods This cohort consisted of patients who completed treatment for their first drug-sensitive TB episode between 2003 and 2015. Addresses were geocoded at neighbourhood level. Data on neighbourhood-level factors were obtained from the Census 2011 (household size, population density) and the City of Cape Town (Socio-Economic Index). Neighbourhood-level TB burden was calculated annually by dividing the number of notified TB episodes by the population in that neighbourhood. Multilevel survival analysis was performed with the outcome recurrent TB, defined as a second episode of TB, and controlling for individual-level risk factors (age, gender and time since first episode in years). Follow-up ended at the second episode, or on 31 December 2015, whichever came first. Results The study included 173 421 patients from 700 neighbourhoods. Higher Socio-Economic Index was associated with a lower risk of recurrence compared with average Socio-Economic Index. An increased risk was found for higher household size and TB burden, with an increase of 20% for every additional person in mean household size and 10% for every additional TB episode/100 inhabitants. No association was found with population density. Conclusion Recurrent TB was associated with increased household size and TB burden at neighbourhood level. These findings could be used to target TB screening activities.
KW - GIS
KW - Health inequalities
KW - SOCIAL CLASS
KW - TUBERCULOSIS
UR - http://www.scopus.com/inward/record.url?scp=85143910581&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/jech-2022-219622
DO - https://doi.org/10.1136/jech-2022-219622
M3 - Article
C2 - 36379714
SN - 0143-005X
VL - 77
SP - 56
EP - 62
JO - Journal of Epidemiology and Community Health
JF - Journal of Epidemiology and Community Health
IS - 1
ER -