Barr R G, Diez-Roux A V, Knirsch C A, Pablos-Méndez A
Division of General Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Am J Public Health. 2001 Sep;91(9):1487-93. doi: 10.2105/ajph.91.9.1487.
The resurgence of tuberculosis (TB) in NewYork City has been attributed to AIDS and immigration; however, the role of poverty in the epidemic is unclear. We assessed the relation between neighborhood poverty and TB at the height of the epidemic and longitudinally from 1984 through 1992.
Census block groups were used as proxies for neighborhoods. For each neighborhood, we calculated TB and AIDS incidence in 1984 and 1992 with data from the Bureaus of Tuberculosis Control and AIDS Surveillance and obtained poverty rates from the census.
For 1992, 3,343 TB cases were mapped to 5,482 neighborhoods, yielding a mean incidence of 46.5 per 100,000. Neighborhood poverty was associated with TB (relative risk = 1.33; 95% confidence interval = 1.30, 1.36 per 10% increase in poverty). This association persisted after adjustment for AIDS, proportion foreign born, and race/ethnicity. Neighborhoods with declining income from 1980 to 1990 had larger increases in TB incidence than did neighborhoods with increasing income.
Leading up to and at the height of the TB epidemic in New York City, neighborhood poverty was strongly associated with TB incidence. Public health interventions should target impoverished areas.
纽约市结核病（TB）的再度流行被归因于艾滋病和移民；然而，贫困在这一流行病中的作用尚不清楚。我们评估了在疫情高峰期以及从1984年至1992年纵向研究中社区贫困与结核病之间的关系。
人口普查街区组被用作社区的代表。对于每个社区，我们利用结核病控制局和艾滋病监测局的数据计算了1984年和1992年的结核病和艾滋病发病率，并从人口普查中获取贫困率。
1992年，3343例结核病病例被映射到5482个社区，平均发病率为每10万人46.5例。社区贫困与结核病相关（相对风险=1.33；95%置信区间=1.30，贫困率每增加10%为1.36）。在对艾滋病、外国出生比例和种族/民族进行调整后，这种关联仍然存在。与收入增加的社区相比，1980年至1990年收入下降的社区结核病发病率上升幅度更大。
在纽约市结核病流行之前及流行高峰期，社区贫困与结核病发病率密切相关。公共卫生干预措施应针对贫困地区。
