La ventaja epidemiológica de la orientación preferencial del control de la tuberculosis hacia los pobres

Translated title of the contribution: The epidemiological advantage of preferential targeting of tuberculosis control at the poor

J. R. Andrews, S. Basu, D. W. Dowdy, M. B. Murray

Research output: Contribution to journalArticle

Abstract

Tuberculosis (TB) remains disproportionately concentrated among the poor, yet known determinants of TB reactivation may fail to explain observed disparities in disease rates according to wealth. Reviewing data on TB disparities in India and the wealth distribution of known TB risk factors, we describe how social mixing patterns could be contributing to TB disparities. Wealth-assortative mixing, whereby individuals are more likely to be in contact with others from similar socio-economic backgrounds, amplifies smaller differences in risk of TB, resulting in large population-level disparities. As disparities and assortativeness increase, TB becomes more difficult to control, an effect that is obscured by looking at population averages of epidemiological parameters, such as case detection rates. We illustrate how TB control efforts may benefit from preferential targeting toward the poor. In India, an equivalent-scale intervention could have a substantially greater impact if targeted at those living below the poverty line than with a population-wide strategy. In addition to potential efficiencies in targeting higher-risk populations, TB control efforts would lead to a greater reduction in secondary TB cases per primary case diagnosed if they were preferentially targeted at the poor. We highlight the need to collect programmatic data on TB disparities and explicitly incorporate equity considerations into TB control plans.

Translated title of the contributionThe epidemiological advantage of preferential targeting of tuberculosis control at the poor
Original languageSpanish
Pages (from-to)186-194
Number of pages9
JournalRevista Panamericana de Salud Publica/Pan American Journal of Public Health
Volume38
Issue number3
StatePublished - Sep 2015

Keywords

  • Disparities
  • Models
  • Policy
  • Poverty
  • Social mixing

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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