Association between socioeconomic position and tuberculosis in a large population-based study in rural Malawi.

<h4>Setting</h4>There is increasing interest in social structural interventions for tuberculosis. The association between poverty and tuberculosis is well established in many settings, but less clear in rural Africa. In Karonga District, Malawi, we found an association between higher soc...

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Main Authors: Anna Odone, Amelia C Crampin, Venance Mwinuka, Simon Malema, J Nimrod Mwaungulu, Lumbani Munthali, Judith R Glynn
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2013-01-01
Series:PLoS ONE
Online Access:https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0077740&type=printable
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author Anna Odone
Amelia C Crampin
Venance Mwinuka
Simon Malema
J Nimrod Mwaungulu
Lumbani Munthali
Judith R Glynn
author_facet Anna Odone
Amelia C Crampin
Venance Mwinuka
Simon Malema
J Nimrod Mwaungulu
Lumbani Munthali
Judith R Glynn
author_sort Anna Odone
collection DOAJ
description <h4>Setting</h4>There is increasing interest in social structural interventions for tuberculosis. The association between poverty and tuberculosis is well established in many settings, but less clear in rural Africa. In Karonga District, Malawi, we found an association between higher socioeconomic status and tuberculosis from 1986-1996, independent of HIV status and other factors.<h4>Objective</h4>To investigate the relationship in the same area in 1997-2010.<h4>Design</h4>All adults in the district with new laboratory-confirmed tuberculosis were included. They were compared with community controls, selected concurrently and frequency-matched for age, sex and area.<h4>Results</h4>1707 cases and 2678 controls were interviewed (response rates >95%). The odds of TB were increased in those working in the cash compared to subsistence economy (p<0.001), and with better housing (p-trend=0.006), but decreased with increased asset ownership (p-trend=0.003). The associations with occupation and housing were partly mediated by HIV status, but remained significant.<h4>Conclusion</h4>Different socioeconomic measures capture different pathways of the association between socioeconomic status and tuberculosis. Subsistence farmers may be relatively unexposed whereas those in the cash economy travel more, and may be more likely to come forward for diagnosis. In this setting "better houses" may be less well ventilated and residents may spend more time indoors.
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spelling doaj-art-cfbaa7aa2f104d03823dc67be3e4b0a72025-08-20T03:46:24ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-01810e7774010.1371/journal.pone.0077740Association between socioeconomic position and tuberculosis in a large population-based study in rural Malawi.Anna OdoneAmelia C CrampinVenance MwinukaSimon MalemaJ Nimrod MwaunguluLumbani MunthaliJudith R Glynn<h4>Setting</h4>There is increasing interest in social structural interventions for tuberculosis. The association between poverty and tuberculosis is well established in many settings, but less clear in rural Africa. In Karonga District, Malawi, we found an association between higher socioeconomic status and tuberculosis from 1986-1996, independent of HIV status and other factors.<h4>Objective</h4>To investigate the relationship in the same area in 1997-2010.<h4>Design</h4>All adults in the district with new laboratory-confirmed tuberculosis were included. They were compared with community controls, selected concurrently and frequency-matched for age, sex and area.<h4>Results</h4>1707 cases and 2678 controls were interviewed (response rates >95%). The odds of TB were increased in those working in the cash compared to subsistence economy (p<0.001), and with better housing (p-trend=0.006), but decreased with increased asset ownership (p-trend=0.003). The associations with occupation and housing were partly mediated by HIV status, but remained significant.<h4>Conclusion</h4>Different socioeconomic measures capture different pathways of the association between socioeconomic status and tuberculosis. Subsistence farmers may be relatively unexposed whereas those in the cash economy travel more, and may be more likely to come forward for diagnosis. In this setting "better houses" may be less well ventilated and residents may spend more time indoors.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0077740&type=printable
spellingShingle Anna Odone
Amelia C Crampin
Venance Mwinuka
Simon Malema
J Nimrod Mwaungulu
Lumbani Munthali
Judith R Glynn
Association between socioeconomic position and tuberculosis in a large population-based study in rural Malawi.
PLoS ONE
title Association between socioeconomic position and tuberculosis in a large population-based study in rural Malawi.
title_full Association between socioeconomic position and tuberculosis in a large population-based study in rural Malawi.
title_fullStr Association between socioeconomic position and tuberculosis in a large population-based study in rural Malawi.
title_full_unstemmed Association between socioeconomic position and tuberculosis in a large population-based study in rural Malawi.
title_short Association between socioeconomic position and tuberculosis in a large population-based study in rural Malawi.
title_sort association between socioeconomic position and tuberculosis in a large population based study in rural malawi
url https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0077740&type=printable
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