Tuberculosis and poverty: why are the poor at greater risk in India?

• Published in: PloS one Vol. 7; no. 11; p. e47533
• Main Authors: Oxlade, Olivia, Murray, Megan
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.11.2012; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Air pollution; Alcohol use; Atmospheric pollution; Biology; Body mass; Body mass index; Body size; Demographics; Determinants; Diabetes; Economic factors; Epidemiology; Female; Health risks; Households; Humans; India; India - epidemiology; Indoor air; Indoor air pollution; Indoor environments; Male; Mediation; Medical research; Medicine; Middle Aged; Platelet-activating factor; Pollution; Poverty; Poverty - economics; Poverty - statistics & numerical data; Prevalence; Principal Component Analysis; Principal components analysis; Regression analysis; Risk analysis; Risk Factors; Self Report; Social factors; Socio-economic aspects; Socioeconomics; Surveys; Tuberculosis; Tuberculosis - economics; Tuberculosis - epidemiology; Young Adult; India; United States > US; Massachusetts
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0047533

Although poverty is widely recognized as an important risk factor for tuberculosis (TB) disease, the specific proximal risk factors that mediate this association are less clear. The objective of our study was to investigate the mechanisms by which poverty increases the risk of TB. Using individual level data from 198,754 people from the 2006 Demographic Health Survey (DHS) for India, we assessed self-reported TB status, TB determinants and household socioeconomic status. We used these data to calculate the population attributable fractions (PAF) for each key TB risk factor based on the prevalence of determinants and estimates of the effect of these risk factors derived from published sources. We conducted a mediation analysis using principal components analysis (PCA) and regression to demonstrate how the association between poverty and TB prevalence is mediated. The prevalence of self-reported TB in the 2006 DHS for India was 545 per 100,000 and ranged from 201 in the highest quintile to 1100 in the lowest quintile. Among those in the poorest population, the PAFs for low body mass index (BMI) and indoor air pollution were 34.2% and 28.5% respectively. The PCA analysis also showed that low BMI had the strongest mediating effect on the association between poverty and prevalent TB (12%, p = 0.019). TB control strategies should be targeted to the poorest populations that are most at risk, and should address the most important determinants of disease--specifically low BMI and indoor air pollution.