Is it better to be rich in a poor area or poor in a rich area? A multilevel analysis of a case-control study of social determinants of tuberculosis
Is it better to be rich in a poor area or poor in a rich area? A multilevel analysis of a case-control study of social determinants of tuberculosis
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DOI：
10.1093/ije/dyp224
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发表时间：
2009-10-01
影响因子：
7.7
通讯作者：
Rodrigues, Laura C.
中科院分区：
文献类型：
--
作者：
de Alencar Ximenes, Ricardo Arraes;Pessoa Militao de Albuquerque, Maria de Fatima;Rodrigues, Laura C.
背景结核病在个人和地区水平上都有社会经济决定因素，但尚不清楚它们是否是独立的，它们是否相互作用以及它们对结核病负担的相对贡献。探讨这两个层面的决定因素之间的关系，并计算它们对结核病负担的相对贡献。它包括1452例结核病诊断的结核病服务和5808控制随机选择的问卷调查完成的人口普查。使用普查中使用的问卷，从案例中收集了关于社会因素的详尽信息。从普查中下载了各地区的社会经济信息。多水平Logistic回归调查个人和地区effects.Results有一个显着的和独立的社会变量对结核病的风险，在个人和地区水平的影响。在个人层面，年龄≥ 20岁、男性、文盲、前7天内没有工作和拥有的物品很少，都增加了患结核病的风险。在地区一级，生活在文盲人数众多、拥有计算机的家庭很少的地区也增加了这种风险;个人和地区一级似乎没有相互作用。两倍多的情况下，可归因于社会变量在个人层面上比在区域level.Conclusions虽然个人特征的主要贡献者结核病的风险，上下文特征作出了重大的独立贡献。
Background Tuberculosis is known to have socio-economic determinants at individual and at area levels, but it is not known whether they are independent, whether they interact and their relative contributions to the burden of tuberculosis.Methods A case-control study was conducted in Recife, Brazil, to investigate individual and area social determinants of tuberculosis, to explore the relationship between determinants at the two levels and to calculate their relative contribution to the burden of tuberculosis. It included 1452 cases of tuberculosis diagnosed by the tuberculosis services and 5808 controls selected at random from questionnaires completed for the demographic census. Exhaustive information on social factors was collected from cases, using the questionnaire used in the census. Socio-economic information for areas was down-loaded from the census. Multilevel logistic regression investigated individual and area effects.Results There was a marked and independent influence of social variables on the risk of tuberculosis, both at individual and area levels. At individual level, being aged >= 20, being male, being illiterate, not working in the previous 7 days and possessing few goods, all increased the risk of tuberculosis. At area level, living in an area with many illiterate people and where few households own a computer also increased this risk; individual and area levels did not appear to interact. Twice as many cases were attributable to social variables at individual level than at area level.Conclusions Although individual characteristics are the main contributor to the risk of tuberculosis, contextual characteristics make a substantial independent contribution.