Mining and risk of tuberculosis in sub-Saharan Africa.
OBJECTIVE
We estimated the relationship between mining and tuberculosis (TB) among countries in sub-Saharan Africa.


METHODS
We used multivariate regression to estimate the contribution of mining activity to TB incidence, prevalence, and mortality, as well as rates of TB among people living with HIV, with control for economic, health system, and population confounders.


RESULTS
Mining production was associated with higher population TB incidence rates (adjusted b = 0.093; 95% confidence interval [CI] = 0.067, 0.120; with an increase of mining production of 1 SD corresponding to about 33% higher TB incidence or 760,000 more incident cases), after adjustment for economic and population controls. Similar results were observed for TB prevalence and mortality, as well as with alternative measures of mining activity. Independent of HIV, there were significant associations between mining production and TB incidence in countries with high HIV prevalence (≥ 4% antenatal HIV prevalence; HIV-adjusted B = 0.066; 95% CI = 0.050, 0.082) and between log gold mining production and TB incidence in all studied countries (HIV-adjusted B = 0.053; 95% CI = 0.032, 0.073).


CONCLUSIONS
Mining is a significant determinant of countrywide variation in TB among sub-Saharan African nations. Comprehensive TB control strategies should explicitly address the role of mining activity and environments in the epidemic.
Department of Global Health and Population, Harvard University, Boston, MA, USA. dstuckler@hsph.harvard.edu
David
D
Stuckler
Sanjay
S
Basu
Martin
M
McKee
Mark
M
Lurie
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D017954:Africa South of the Sahara / Q000453:epidemiology; D016001:Confidence Intervals; D006801:Humans; D015994:Incidence; D008906:Mining; D009784:Occupational Diseases / Q000453:epidemiology*; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D014376:Tuberculosis / Q000453:epidemiology*