TB Modelling Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLoS Med. 2022 Mar 18;19(3):e1003935. doi: 10.1371/journal.pmed.1003935. eCollection 2022 Mar.
An ecological relationship between economic development and reduction in tuberculosis prevalence has been observed. Between 2007 and 2017, Việt Nam experienced rapid economic development with equitable distribution of resources and a 37% reduction in tuberculosis prevalence. Analysing consecutive prevalence surveys, we examined how the reduction in tuberculosis (and subclinical tuberculosis) prevalence was concentrated between socioeconomic groups.
We combined data from 2 nationally representative Việt Nam tuberculosis prevalence surveys with provincial-level measures of poverty. Data from 94,156 (2007) and 61,763 (2017) individuals were included. Of people with microbiologically confirmed tuberculosis, 21.6% (47/218) in 2007 and 29.0% (36/124) in 2017 had subclinical disease. We constructed an asset index using principal component analysis of consumption data. An illness concentration index was estimated to measure socioeconomic position inequality in tuberculosis prevalence. The illness concentration index changed from -0.10 (95% CI -0.08, -0.16; p = 0.003) in 2007 to 0.07 (95% CI 0.06, 0.18; p = 0.158) in 2017, indicating that tuberculosis was concentrated among the poorest households in 2007, with a shift towards more equal distribution between rich and poor households in 2017. This finding was similar for subclinical tuberculosis. We fitted multilevel models to investigate relationships between change in tuberculosis prevalence, individual risks, household socioeconomic position, and neighbourhood poverty. Controlling for provincial poverty level reduced the difference in prevalence, suggesting that changes in neighbourhood poverty contribute to the explanation of change in tuberculosis prevalence. A limitation of our study is that while tuberculosis prevalence surveys are valuable for understanding socioeconomic differences in tuberculosis prevalence in countries, given that tuberculosis is a relatively rare disease in the population studied, there is limited power to explore socioeconomic drivers. However, combining repeated cross-sectional surveys with provincial deprivation estimates during a period of remarkable economic growth provides valuable insights into the dynamics of the relationship between tuberculosis and economic development in Việt Nam.
We found that with equitable economic growth and a reduction in tuberculosis burden, tuberculosis became less concentrated among the poor in Việt Nam.
经济发展与结核病发病率下降之间存在生态关系。2007 年至 2017 年期间，越南经历了资源公平分配和结核病发病率下降 37%的快速经济发展。通过对连续的流行情况调查进行分析，我们研究了结核病（和亚临床结核病）发病率的下降是如何集中在社会经济群体之间的。
我们将来自全国具有代表性的 2 次越南结核病流行情况调查的数据与省级贫困程度衡量标准相结合。纳入了 94156 名（2007 年）和 61763 名（2017 年）个人的数据。在经微生物学证实的结核病患者中，2007 年有 21.6%（47/218）和 2017 年有 29.0%（36/124）患有亚临床疾病。我们使用消费数据的主成分分析构建了资产指数。使用疾病集中指数来衡量结核病发病率的社会经济地位不平等。2007 年，疾病集中指数为-0.10（95%CI -0.08，-0.16；p=0.003），2017 年为 0.07（95%CI 0.06，0.18；p=0.158），这表明 2007 年结核病集中在最贫困的家庭中，而 2017 年则向贫富家庭之间更公平的分布转变。亚临床结核病也有类似的发现。我们拟合了多水平模型，以调查结核病发病率变化、个体风险、家庭社会经济地位和邻里贫困之间的关系。控制省级贫困水平降低了患病率差异，表明邻里贫困的变化有助于解释结核病发病率的变化。我们研究的一个局限性是，虽然结核病流行情况调查对于了解国家结核病发病率的社会经济差异很有价值，但由于结核病在研究人群中相对罕见，因此在探索社会经济驱动因素方面的能力有限。然而，将重复的横断面调查与经济增长时期的省级贫困程度估计相结合，为深入了解越南结核病与经济发展之间的关系动态提供了宝贵的见解。
我们发现，随着经济的公平增长和结核病负担的减轻，越南的结核病在贫困人口中的集中程度降低。
