Neighbourhood risk factors of recurrent tuberculosis in Cape Town: a cohort study using geocoded notification data

BackgroundIndividuals 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...

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Bibliographic Details
Published in:Journal of epidemiology and community health (1979) 2022-11, Vol.77 (1), p.56-62
Main Authors: Molemans, Marjan, van Leth, Frank, McKelly, David Henry, Wood, Robin, Hermans, Sabine
Format: Article
Language:English
Subjects:
Age
Cohort analysis
Economics
Environmental factors
Gender
GIS
Health inequalities
Households
Malnutrition
Neighborhoods
Original research
Patients
Population density
Risk factors
SOCIAL CLASS
Socioeconomic factors
Socioeconomics
Survival analysis
TUBERCULOSIS
Ventilation
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Summary:BackgroundIndividuals 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.MethodsThis 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.ResultsThe 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.ConclusionRecurrent TB was associated with increased household size and TB burden at neighbourhood level. These findings could be used to target TB screening activities.
ISSN:0143-005X
1470-2738
DOI:10.1136/jech-2022-219622