[Influence of social inequality, social unrest and extreme poverty on tuberculosis morbidity in the City of Barcelona].
BACKGROUND
The main purpose of this study was to analyse inequalities between tuberculosis/intravenous drug user and tuberculosis/not intravenous drug user among the different neighbourhoods of Barcelona and the relationship to socioeconomic indicators and social/material deprivation indicators throughout the 1990-1995 period.


METHODS
An ecological study which included all cases of tuberculosis among residents of Barcelona, the analysis unit being the neighbourhood. Intravenous drug users within the 15-49 age range and non-intravenous drug users over age 14 were included. The mean annual incidence rate standardized by age was used. The social indicators considered were the inner city areas, unemployment, less than primary education, overcrowding, social unrest and extreme poverty. In the bivariate analysis, the relationship between tuberculosis incidence and the social indicators was studied by means of the Spearman correlation coefficient, and the multivariate analysis by means of the Poisson regression.


RESULTS
The incidence rates were higher in the inner city neighbourhoods, followed by the newer outlying working class neighbourhoods in both groups studied, and in other older outlying districts for the non-users of intravenous drugs. Among the intravenous drug user group, the variables related to a greater risk of tuberculosis were: man (RR = 7.42, confidence interval at 95% ICI95%-: 6.16-8.93), age (RR = 61.51, CI95%: 34.64-109.20), unemployment (RR = 1.68, CI95%: 1.51-1.88), social unrest (RR = 1.29, CI 95%: 1.04-1.58), overcrowding (RR = 1.36, CI 95%: 1.19-1.55) and inner city areas (RR = 1.92, CI 95% 1.48-2.50). Among the male non-users of intravenous drugs, no interaction between unemployment and age was found. Neighbourhoods with extreme poverty and inner city neighbourhoods showed a higher risk of tuberculosis (RR = 1.11, CI 95% 1.08-1.135 and RR = 1.80, CI95%: 1.51-2.14). Among the female non-users of intravenous drugs, a relationship was found in those of lesser age (RR = 1.29, CI 95%: 1.05-1.57), unemployment (RR = 1.18, CI 95%: 1.09-1.26), extreme poverty (RR = 1.95, CI 95%: 1.56-2.45) and inner city areas (RR = 1.72, CI 95%: 1.35-2.19).


CONCLUSIONS
Inequalities in tuberculosis are related to different social indicators such as unemployment and inner city areas. A difference exists between the two groups studied. Tuberculosis is related with social unrest and overcrowding among intravenous drug users and with extreme poverty among non-users of intravenous drugs.
Díaz de Quijano
E
E
Servei d'Epidemiologia, Institut Municipal de Salut Pública de Barcelona, Pl. Lesseps 1 08023 Barcelona. estela@imsb.bcn.es
Brugal
M T
MT
Pasarín
M I
MI
Galdós-Tangüís
H
H
Caylà
J
J
Borrell
C
C
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology*