Díaz de Quijano E, Brugal M T, Pasarín M I, Galdós-Tangüís H, Caylà J, Borrell C
Servei d'Epidemiologia, Institut Municipal de Salut Pública de Barcelona, Pl. Lesseps 1 08023 Barcelona.
Rev Esp Salud Publica. 2001 Nov-Dec;75(6):517-27.
The main purpose of this study was to analyse inequalities between tuberculosis/intravenous drug user and tuberculosis/not intravenous drug user among the different neighbourhoods of Barcelona and the relationship to socioeconomic indicators and social/material deprivation indicators throughout the 1990-1995 period.
An ecological study which included all cases of tuberculosis among residents of Barcelona, the analysis unit being the neighbourhood. Intravenous drug users within the 15-49 age range and non-intravenous drug users over age 14 were included. The mean annual incidence rate standardized by age was used. The social indicators considered were the inner city areas, unemployment, less than primary education, overcrowding, social unrest and extreme poverty. In the bivariate analysis, the relationship between tuberculosis incidence and the social indicators was studied by means of the Spearman correlation coefficient, and the multivariate analysis by means of the Poisson regression.
The incidence rates were higher in the inner city neighbourhoods, followed by the newer outlying working class neighbourhoods in both groups studied, and in other older outlying districts for the non-users of intravenous drugs. Among the intravenous drug user group, the variables related to a greater risk of tuberculosis were: man (RR = 7.42, confidence interval at 95% ICI95%-: 6.16-8.93), age (RR = 61.51, CI95%: 34.64-109.20), unemployment (RR = 1.68, CI95%: 1.51-1.88), social unrest (RR = 1.29, CI 95%: 1.04-1.58), overcrowding (RR = 1.36, CI 95%: 1.19-1.55) and inner city areas (RR = 1.92, CI 95% 1.48-2.50). Among the male non-users of intravenous drugs, no interaction between unemployment and age was found. Neighbourhoods with extreme poverty and inner city neighbourhoods showed a higher risk of tuberculosis (RR = 1.11, CI 95% 1.08-1.135 and RR = 1.80, CI95%: 1.51-2.14). Among the female non-users of intravenous drugs, a relationship was found in those of lesser age (RR = 1.29, CI 95%: 1.05-1.57), unemployment (RR = 1.18, CI 95%: 1.09-1.26), extreme poverty (RR = 1.95, CI 95%: 1.56-2.45) and inner city areas (RR = 1.72, CI 95%: 1.35-2.19).
Inequalities in tuberculosis are related to different social indicators such as unemployment and inner city areas. A difference exists between the two groups studied. Tuberculosis is related with social unrest and overcrowding among intravenous drug users and with extreme poverty among non-users of intravenous drugs.
本研究的主要目的是分析1990 - 1995年期间巴塞罗那不同社区中结核病/静脉吸毒者与结核病/非静脉吸毒者之间的不平等情况，以及与社会经济指标和社会/物质匮乏指标的关系。
一项生态学研究，纳入了巴塞罗那居民中的所有结核病例，分析单位为社区。纳入年龄在15 - 49岁的静脉吸毒者和14岁以上的非静脉吸毒者。使用年龄标准化的年平均发病率。所考虑的社会指标包括市中心区域、失业、未接受初等教育、过度拥挤、社会动荡和极端贫困。在双变量分析中，通过Spearman相关系数研究结核病发病率与社会指标之间的关系，多变量分析采用Poisson回归。
市中心社区的发病率较高，在研究的两组中，其次是较新的外围工人阶级社区，对于非静脉吸毒者来说，其他较老的外围地区发病率也较高。在静脉吸毒者组中，与结核病风险较高相关的变量有：男性（相对危险度RR = 7.42，95%置信区间ICI95%：6.16 - 8.93）、年龄（RR = 61.51，CI95%：34.64 - 109.20）、失业（RR = 1.68，CI95%：1.51 - 1.88）、社会动荡（RR = 1.29，CI 95%：1.04 - 1.58）、过度拥挤（RR = 1.36，CI 95%：1.19 - 1.55）和市中心区域（RR = 1.92，CI 95% 1.48 - 2.50）。在男性非静脉吸毒者中，未发现失业与年龄之间存在相互作用。极端贫困社区和市中心社区的结核病风险较高（RR = 1.11，CI 95% 1.08 - 1.135和RR = 1.80，CI95%：1.51 - 2.14）。在女性非静脉吸毒者中，在年龄较小者（RR = 1.29，CI 95%：1.05 - 1.57）、失业（RR = 1.18，CI 95%：1.09 - 1.26）、极端贫困（RR = 1.95，CI 95%：1.56 - 2.45）和市中心区域（RR = 1.72，CI 95%：1.35 - 2.19）中发现了相关性。
结核病的不平等与不同的社会指标如失业和市中心区域有关。研究的两组之间存在差异。结核病与静脉吸毒者中的社会动荡和过度拥挤以及非静脉吸毒者中的极端贫困有关。
