Neighborhood poverty and the resurgence of tuberculosis in New York City, 1984-1992.
OBJECTIVE
The resurgence of tuberculosis (TB) in NewYork City has been attributed to AIDS and immigration; however, the role of poverty in the epidemic is unclear. We assessed the relation between neighborhood poverty and TB at the height of the epidemic and longitudinally from 1984 through 1992.


METHODS
Census block groups were used as proxies for neighborhoods. For each neighborhood, we calculated TB and AIDS incidence in 1984 and 1992 with data from the Bureaus of Tuberculosis Control and AIDS Surveillance and obtained poverty rates from the census.


RESULTS
For 1992, 3,343 TB cases were mapped to 5,482 neighborhoods, yielding a mean incidence of 46.5 per 100,000. Neighborhood poverty was associated with TB (relative risk = 1.33; 95% confidence interval = 1.30, 1.36 per 10% increase in poverty). This association persisted after adjustment for AIDS, proportion foreign born, and race/ethnicity. Neighborhoods with declining income from 1980 to 1990 had larger increases in TB incidence than did neighborhoods with increasing income.


CONCLUSIONS
Leading up to and at the height of the TB epidemic in New York City, neighborhood poverty was strongly associated with TB incidence. Public health interventions should target impoverished areas.
Barr
R G
RG
Division of General Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA. rgb9@columbia.edu
Diez-Roux
A V
AV
Knirsch
C A
CA
Pablos-Méndez
A
A
D000328:Adult; D021821:Communicable Diseases, Emerging / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007182:Income / Q000706:statistics & numerical data / Q000639:trends; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D011159:Population Surveillance; D011203:Poverty / Q000706:statistics & numerical data* / Q000639:trends; D012044:Regression Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D014376:Tuberculosis / Q000453:epidemiology*; D014504:Urban Health / Q000706:statistics & numerical data* / Q000639:trends