Yates, TA;
Ayles, H;
Leacy, FP;
Schaap, A;
Boccia, D;
Beyers, N;
Godfrey-Faussett, P;
(2018)
Socio-economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa.
Tropical Medicine & International Health
, 23
(4)
pp. 375-390.
10.1111/tmi.13038.
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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.
| Type: | Article |
|---|---|
| Title: | Socio-economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/tmi.13038 |
| Publisher version: | https://doi.org/10.1111/tmi.13038 |
| Language: | English |
| Additional information: | This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Public, Environmental & Occupational Health, Tropical Medicine, tuberculosis, social epidemiology, HIV, Zambia, South Africa, MIDDLE-INCOME COUNTRIES, PULMONARY TUBERCULOSIS, MULTILEVEL ANALYSIS, RANDOMIZED-TRIAL, NATIONAL-SURVEY, HIV PREVALENCE, COMMUNITY, BURDEN, EPIDEMIOLOGY, TRANSMISSION |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10051898 |
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