Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, PO Box 13801, Mowbray Observatory, Cape Town, 7705, South Africa.
NRF/DST Centre of Excellence for Biomedical Tuberculosis Research, Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.
BMC Infect Dis. 2020 Feb 10;20(1):120. doi: 10.1186/s12879-020-4828-z.
While several studies have assessed the associations between biological factors and tuberculosis (TB) transmission, our understanding of the associations between TB transmission and social and economic factors remains incomplete. We aimed to explore associations between community TB transmission and socio-economic factors within a high TB-HIV burdened setting.
We conducted a cross-sectional molecular epidemiology study among adult patients attending a routine TB clinic. Demographic and clinical data were extracted from TB registers and clinical folders; social and economic data were collected using interviewer-administered questionnaires; Mycobacterium tuberculosis isolates were genotyped and classified as clustered/non-clustered using IS6110-based Restriction Fragment Length Polymorphism. Composite "social" and "economic" scores were generated from social and economic data. Data were analyzed using StataCorp version 15.0 software. Stratified, bivariable analyses were performed using chi-squared. Wilcoxon signed rank tests; univariable and multivariable logistic regression models were developed to explore associations in the social, economic, traditional and composite TB risk factors with TB transmission.
Of the 505 patient Mtb strains, 348(69%) cases were classified as clustered and 157(31%) were non-clustered. Clustered cases were more likely to have lived longer in the study community, (odds ratio [OR] = 1.05, 95% Confidence interval [C.I]:1.02-1.09, p = 0.006); in the same house (OR = 1.04, C.I: 0.99-1.08, p = 0.06); and had increased household crowding conditions (i.e fewer rooms used for sleeping, OR = 0.45, C.I:0.21-0.95, p = 0.04). Although a higher proportion of clustered cases had a low economic score, no statistically significant association was found between clustering and either the economic score (p = 0.13) or social score (p = 0.26).
We report a novel association between Mtb transmission and prolonged stay within a high burdened community. Transmission was also associated with fewer rooms for sleeping in a household. Increased social interaction and prolonged residence in a high burdened community are important factors linked to Mtb transmission, possibly due to increased probability of higher effective contact rates. The possible importance of degrees of poverty within low socio-economic setting warrants further study.
虽然有几项研究评估了生物因素与结核病（TB）传播之间的关联，但我们对 TB 传播与社会经济因素之间的关联仍了解不足。本研究旨在探索高结核/艾滋病毒负担环境中社区 TB 传播与社会经济因素之间的关联。
我们对在常规 TB 诊所就诊的成年患者进行了横断面分子流行病学研究。从 TB 登记册和临床档案中提取人口统计学和临床数据；使用访谈者管理的问卷收集社会经济数据；使用基于 IS6110 的限制性片段长度多态性对分枝杆菌结核分离株进行基因分型，并分类为聚类/非聚类。从社会经济数据中生成综合“社会”和“经济”评分。使用 StataCorp 版本 15.0 软件进行数据分析。使用卡方检验进行分层、双变量分析。Wilcoxon 符号秩检验；使用单变量和多变量逻辑回归模型探索与 TB 传播相关的社会、经济、传统和综合 TB 危险因素的关联。
在 505 株患者分枝杆菌中，348（69%）例为聚类，157（31%）例为非聚类。聚类病例在研究社区的居住时间更长（比值比[OR] = 1.05，95%置信区间[CI]：1.02-1.09，p = 0.006）；住在同一所房子里（OR = 1.04，CI：0.99-1.08，p = 0.06）；且家庭拥挤条件增加（即用于睡眠的房间较少，OR = 0.45，CI：0.21-0.95，p = 0.04）。尽管聚类病例中较高比例的经济评分较低，但聚类与经济评分（p = 0.13）或社会评分（p = 0.26）之间没有统计学显著关联。
我们报告了分枝杆菌传播与在高负担社区中长时间停留之间的新关联。传播也与家庭中用于睡眠的房间较少有关。增加的社会互动和在高负担社区的长期居住是与分枝杆菌传播相关的重要因素，这可能是由于更高的有效接触率的可能性增加所致。在低社会经济环境中贫困程度的重要性值得进一步研究。
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