Social inequalities in HIV-TB and non-HIV-TB patients in two urban areas in southern Spain: multilevel analysis.
METHODS
Two towns in Campo de Gibraltar, southern Spain, with a small foreign population and higher tuberculosis (TB) incidence and human immunodeficiency virus (HIV) prevalence than the national average.


OBJECTIVE
To determine the relationship between HIV-TB and non-HIV-TB incidence and social deprivation and other potential individual and contextual determinants.


METHODS
In a cross-sectional longitudinal study, individual TB case variables were identified from three sources--routine surveillance, laboratory and hospital discharge records--from 1997 to 2007. Community variables were obtained at the census tract level. A deprivation index was calculated based on percentages of unemployment, low educational level and unskilled labour. Multilevel Poisson models were estimated for TB incidence rates for patients with and without HIV.


RESULTS
A total of 490 TB cases were included. Sex and age at individual level and deprivation and residence in the port area at census tract level were associated both with HIV-related TB and with non-HIV-TB. Household crowding contextual variables were also associated with HIV-related TB incidence. Full models account for 78.9% and 51.7% reductions in second-level variance.


CONCLUSIONS
Socio-economic deprivation is associated with higher rates of HIV-TB and non-HIV-TB. Diverse individual and contextual potential risk factors suggest different pathways of transmission. It is necessary to extend the framework for intervention beyond individual-based strategies to the socio-economic contexts in which people live.
Delegación Provincial de Salud de Cádiz, Consejería de Salud de la Junta de Andalucía, Cádiz, Spain. jantonio.cordoba@juntadeandalucia.es
J A
JA
Córdoba-Doña
J P
JP
Novalbos-Ruiz
J
J
Suárez-Farfante
G
G
Andérica-Frías
A
A
Escolar-Pujolar
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D011159:Population Surveillance; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology* / Q000635:transmission; D014504:Urban Health; D055815:Young Adult