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Tuberculosis and Poverty: Why Are the Poor at Greater Risk in India?

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  • Olivia Oxlade
  • Megan Murray

Abstract

Background: 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. Methods: 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. Results: 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). Conclusion: 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.

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  • Olivia Oxlade & Megan Murray, 2012. "Tuberculosis and Poverty: Why Are the Poor at Greater Risk in India?," PLOS ONE, Public Library of Science, vol. 7(11), pages 1-8, November.
    • Handle: RePEc:plo:pone00:0047533
    DOI: 10.1371/journal.pone.0047533
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    3. Yiran Cui & Hui Shen & Fang Wang & Haoyu Wen & Zixin Zeng & Yafeng Wang & Chuanhua Yu, 2020. "A Long-Term Trend Study of Tuberculosis Incidence in China, India and United States 1992–2017: A Joinpoint and Age–Period–Cohort Analysis," IJERPH, MDPI, vol. 17(9), pages 1-19, May.
    4. Laishram Ladusingh & Sanjay Kumar Mohanty & Melody Thangjam, 2018. "Triple burden of disease and out of pocket healthcare expenditure of women in India," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-13, May.
    5. Anshul Kastor & Sanjay K Mohanty, 2018. "Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: Do Indian households face distress health financing?," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-18, May.
    6. Anna Odone & Roger Calderon & Mercedes C Becerra & Zibiao Zhang & Carmen C Contreras & Rosa Yataco & Jerome Galea & Leonid Lecca & Matthew H Bonds & Carole D Mitnick & Megan B Murray, 2016. "Acquired and Transmitted Multidrug Resistant Tuberculosis: The Role of Social Determinants," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-7, January.
    7. Gulzar Hussain Shah & Raimi Ewetola & Gina Etheredge & Lievain Maluantesa & Kristie Waterfield & Elodie Engetele & Apolinaire Kilundu, 2021. "Risk Factors for TB/HIV Coinfection and Consequences for Patient Outcomes: Evidence from 241 Clinics in the Democratic Republic of Congo," IJERPH, MDPI, vol. 18(10), pages 1-13, May.
    8. Zhang, Li & Xie, Lunyu & Zheng, Xinye, 2020. "Moving to Opportunity: The Effects of the Targeted Poverty Alleviation Relocation Program in China," 2020 Annual Meeting, July 26-28, Kansas City, Missouri 304314, Agricultural and Applied Economics Association.
    9. Michael Matsangos & Laoura Ziaka & Artistomenis K. Exadaktylos & Jolanta Klukowska-Rötzler & Mairi Ziaka, 2022. "Health Status of Afghan Refugees in Europe: Policy and Practice Implications for an Optimised Healthcare," IJERPH, MDPI, vol. 19(15), pages 1-13, July.
    10. Anna Odone & Amelia C Crampin & Venance Mwinuka & Simon Malema & J Nimrod Mwaungulu & Lumbani Munthali & Judith R Glynn, 2013. "Association between Socioeconomic Position and Tuberculosis in a Large Population-Based Study in Rural Malawi," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-1, October.
    11. Sterck, Olivier, 2016. "Natural resources and the spread of HIV/AIDS: Curse or blessing?," Social Science & Medicine, Elsevier, vol. 150(C), pages 271-278.
    12. Janmejaya Samal, 2018. "Health System and Policy Perspectives of Multidrug-resistant Tuberculosis (MDR-TB) Control in India," Journal of Development Policy and Practice, , vol. 3(1), pages 1-15, January.
    13. Kustanto, Andi, 2020. "The role of socioeconomic and environmental factors on the number of tuberculosis cases in Indonesia," OSF Preprints ad3uv, Center for Open Science.

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