CHILDHOOD TUBERCULOSIS IN THE BRONX, NEW-YORK
CHILDHOOD TUBERCULOSIS IN THE BRONX, NEW-YORK
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DOI：
10.1016/s0140-6736(94)92588-7
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发表时间：
1994-06-11
期刊：
影响因子：
168.9
通讯作者：
SCKELL, B
中科院分区：
文献类型：
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作者：
DRUCKER, E;ALCABES, P;SCKELL, B
1978- 1992年期间结核病在纽约市的复苏与艾滋病流行密切相关，但城市贫困地区活动性结核病的增加也意味着社区暴露的增加。我们研究了社区艾滋病发病率与居住拥挤和布朗克斯5岁以下儿童活动性结核病病例之间的生态关系。住宅拥挤度被定义为每个房间超过1人的家庭的百分比。包括1986年至1992年期间布朗克斯报告的所有儿童结核病例（n = 75）。到1990年，成年女性的累计艾滋病死亡率代表了社区艾滋病毒负担。所有数据均由该区的64个卫生区编码。我们研究了这些数据的趋势，并使用泊松回归来模拟艾滋病毒负担和居住拥挤对结核病风险的影响。对于布朗克斯作为一个整体，结核病和居住拥挤这两个变量在1970-90年期间显示出明显的时间对应关系。居住拥挤与贫困和更大程度上依赖公共援助，大家庭规模，西班牙裔，和幼儿的比例较高。整体结核病个案率随挤迫住户比例上升而上升，由每万名儿童1.47宗上升至逾8宗。在这些地区艾滋病死亡率最低和最高的地区，儿童结核病风险随着拥挤程度的增加而增加。生活在布朗克斯超过12%的家庭严重拥挤的地区的儿童患活动性结核病的可能性高出5.6倍，即使在每个当地社区假定的艾滋病毒负担保持不变的情况下。虽然艾滋病毒感染是结核病的最新风险因素，似乎在结核病流行的死灰复燃中发挥了关键作用，但我们的研究结果表明，最早已知的结核病风险因素，贫困和家庭拥挤，仍然是强大的力量。
The resurgence of tuberculosis (TB) in New York City in the period 1978-92 has been closely linked to the AIDS epidemic but the increase of active TB in areas of urban poverty also implies increased community exposure. We have examined the ecological relation between community rates of AIDS and residential crowding and cases of active TB in Bronx children under age 5. Residential crowding was defined as the percent of households with more than 1 person per room. All childhood TB cases reported between 1986 and 1992 for the Bronx (n = 75) were included. Cumulative AIDS mortality rates for adult females through 1990 represented community HIV burden. All data were coded by the 64 health areas of the borough. We examined trends in these data and used Poisson regression to model the effect of HIV burden and residential crowding on TB risk.For the Bronx as a whole the two variables of TB and residential crowding showed a clear temporal correspondence for the period 1970-90. Residential crowding was associated with poverty and greater dependence on public assistance, large household size, Hispanic ethnicity, and a higher proportion of young children. The overall TB case rate increased with the proportion of crowded households, with a rise from 1.47 to over 8 cases per 10 000 children as the proportion of crowded households increased. At both the lowest and highest levels of AIDS mortality in these areas, the childhood TB risk increased as crowding increased. Children living in areas of the Bronx in which over 12 percent of homes are severely overcrowded were 5.6-fold more likely to develop active TB, even after holding constant the presumed HIV burden in each local community.While HIV infection, the newest risk factor for TB, appears to play a critical role in the resurgent epidemic, our findings show that the earliest known TB risk factors, poverty and household crowding, are still potent forces.