Department of Global Health and Population, Harvard University, Boston, MA, USA.
Am J Public Health. 2011 Mar;101(3):524-30. doi: 10.2105/AJPH.2009.175646. Epub 2010 Jun 1.
We estimated the relationship between mining and tuberculosis (TB) among countries in sub-Saharan Africa.
We used multivariate regression to estimate the contribution of mining activity to TB incidence, prevalence, and mortality, as well as rates of TB among people living with HIV, with control for economic, health system, and population confounders.
Mining production was associated with higher population TB incidence rates (adjusted b = 0.093; 95% confidence interval [CI] = 0.067, 0.120; with an increase of mining production of 1 SD corresponding to about 33% higher TB incidence or 760,000 more incident cases), after adjustment for economic and population controls. Similar results were observed for TB prevalence and mortality, as well as with alternative measures of mining activity. Independent of HIV, there were significant associations between mining production and TB incidence in countries with high HIV prevalence (≥ 4% antenatal HIV prevalence; HIV-adjusted B = 0.066; 95% CI = 0.050, 0.082) and between log gold mining production and TB incidence in all studied countries (HIV-adjusted B = 0.053; 95% CI = 0.032, 0.073).
Mining is a significant determinant of countrywide variation in TB among sub-Saharan African nations. Comprehensive TB control strategies should explicitly address the role of mining activity and environments in the epidemic.
我们评估了撒哈拉以南非洲国家的采矿业与结核病（TB）之间的关系。
我们使用多元回归来估计采矿业活动对 TB 发病率、患病率和死亡率的贡献，以及艾滋病毒感染者中 TB 的发生率，同时控制经济、卫生系统和人口混杂因素。
在调整了经济和人口控制因素后，采矿业产量与较高的人群结核病发病率相关（调整后 b = 0.093；95%置信区间 [CI] = 0.067，0.120；采矿业产量每增加 1 个标准差，TB 发病率约增加 33%，即新增病例 760,000 例）。TB 患病率和死亡率也存在类似的结果，以及采矿业活动的替代衡量标准也是如此。独立于 HIV 因素，在 HIV 流行率较高（≥4%的产前 HIV 流行率）的国家中，采矿业产量与 TB 发病率之间存在显著关联（HIV 调整后 B = 0.066；95%CI = 0.050，0.082），而在所有研究国家中，金矿开采产量的对数与 TB 发病率之间也存在显著关联（HIV 调整后 B = 0.053；95%CI = 0.032，0.073）。
采矿业是撒哈拉以南非洲国家全国范围内结核病变化的重要决定因素。全面的结核病控制策略应明确解决采矿业活动和环境在该流行中的作用。
