title: Investigating urban-rural disparities in tuberculosis treatment outcome in England and Wales.
abstract: The purpose of this study was to compare the occurrence of tuberculosis (TB) and the outcome of treatment between TB patients living in urban and rural areas. Cases of TB reported from 2001 to 2003 in England and Wales were assigned to a rural or urban area classification. The outcome of interest, non-completion of treatment, was investigated to determine the odds ratio for urban vs. rural residence. The effects of age, sex, ethnicity, place of birth, time since arrival in the United Kingdom, disease site, isoniazid resistance and previous diagnosis were adjusted for by multivariable logistic regression. Crude odds ratios showed a significantly higher level of treatment non-completion in rural areas. These results became non-significant (OR 1.02, 95% CI 0.83-1.26, P=0.82) after adjusting for the confounding effects of ethnic group and age. In England and Wales residence in a rural location is not an independent determinant of TB treatment outcome failure.
authors.affiliation: Respiratory Diseases Department, Centre for Infections, Health Protection Agency, London, UK. Ibrahim.Abubakar@hpa.org.uk
authors.forename: I
authors.initials: I
authors.lastname: Abubakar
authors.forename: J P
authors.initials: JP
authors.lastname: Crofts
authors.forename: D
authors.initials: D
authors.lastname: Gelb
authors.forename: A
authors.initials: A
authors.lastname: Story
authors.forename: N
authors.initials: N
authors.lastname: Andrews
authors.forename: J M
authors.initials: JM
authors.lastname: Watson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011159:Population Surveillance; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013222:State Medicine; D017211:Treatment Failure; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control*; D019037:Urban Health Services / Q000706:statistics & numerical data*; D014852:Wales / Q000453:epidemiology