title: School life expectancy and risk for tuberculosis in Europe.
abstract: OBJECTIVE
  This study aims to investigate the effect of country-level school life expectancy on Tuberculosis (TB) incidence to gain further understanding of substantial variation in TB incidence across Europe.
  
  
  METHODS
  An ecological study examined the prospective association between baseline country-level education in 2000 measured by school life expectancy and TB incidence in 2000-2010 in 40 countries of the WHO European region using quantile regression. Subsequently, to validate the ecological associations between education and TB incidence, an individual-level analysis was performed using case-based data in 29 EU/EEA countries from the European Surveillance System (TESSy) and simulating a theoretical control group.
  
  
  RESULTS
  The ecological analysis showed that baseline school life expectancy had a negative prospective association with TB incidence. We observed consistent negative effects of school life expectancy on individuals' TB infections prospectively.
  
  
  CONCLUSIONS
  These findings suggests that country-level education is an important determinant of individual-level TB infection in the region, and in the absence of a social determinants indicator that is routinely collected for reportable infectious diseases, the adoption of country-level education for reportable infectious diseases would significantly advance the field.
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Machiyama
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11A, 171 82, Stockholm, Sweden. jan.semenza@ecdc.europa.eu.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Semenza
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Silverwood
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Palmer
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11A, 171 82, Stockholm, Sweden.
authors.forename: Tek-Ang
authors.initials: TA
authors.lastname: Lim
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11A, 171 82, Stockholm, Sweden.
authors.forename: Davide
authors.initials: D
authors.lastname: Manissero
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11A, 171 82, Stockholm, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Sandgren
authors.affiliation: Department of Social Science, Centre for Longitudinal Studies, UCL - Institute of Education, University College London, 55-59 Gordon Square, London, WC1H 0NU, UK.
authors.forename: George B
authors.initials: GB
authors.lastname: Ploubidis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012424:Rural Population; D064890:Social Determinants of Health; D014376:Tuberculosis / Q000209:etiology*; D055815:Young Adult
keywords: Education; Epidemiology; Europe; Social determinants of health; Tuberculosis