title: Working conditions and tuberculosis mortality in England and Wales, 1890-1912: a retrospective analysis of routinely collected data.
abstract: Modelling studies suggest that workplaces may be important sites of Mycobacterium tuberculosis transmission in high burden countries today. Contemporary data on tuberculosis by occupation from these settings are scarce. However, historical data on tuberculosis risk in different occupations are available and may provide insight into workplace transmission. We aimed to ascertain whether, in a high burden setting, individuals working in crowded indoor environments (exposed) had greater tuberculosis mortality than individuals employed elsewhere (unexposed).
  
  
  
  The Registrar General's Decennial Supplements from 1890-2, 1900-2 and 1910-2 contain data on mortality from tuberculosis by occupation for men in England and Wales. In these data, the association between occupational exposure to crowded indoor environments and tuberculosis mortality was assessed using an overdispersed Poisson regression model adjusting for socioeconomic position, age and decade.
  
  
  
  There were 23,962 deaths from tuberculosis during 14.8 million person-years of follow-up among men working in exposed occupations and 28,483 during 19.9 million person-years of follow-up among men working in unexposed occupations. We were unable to categorise a large number of occupations as exposed or unexposed. The adjusted rate ratio for death from tuberculosis was 1.34 (95 % confidence interval 1.26-1.43) comparing men working in exposed occupations to those in unexposed occupations.
  
  
  
  Tuberculosis mortality in England and Wales at the turn of the 20th century was associated with occupational exposure to crowded indoor environments. The association between working conditions and TB in contemporary high burden settings requires further study.
authors.affiliation: Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, University College London, 4th Floor Mortimer Market, off Capper Street, London, WC1E 6JB, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Jackson
authors.affiliation: Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, University College London, 4th Floor Mortimer Market, off Capper Street, London, WC1E 6JB, UK.
authors.forename: Joanna H
authors.initials: JH
authors.lastname: Mostowy
authors.affiliation: Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, University College London, 4th Floor Mortimer Market, off Capper Street, London, WC1E 6JB, UK.
authors.forename: Helen R
authors.initials: HR
authors.lastname: Stagg
authors.affiliation: Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, University College London, 4th Floor Mortimer Market, off Capper Street, London, WC1E 6JB, UK.|MRC Clinical Trials Unit at University College London, Aviation House, 125 Kingsway, London, WC2B 6NH, UK.|Tuberculosis Section, Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abubakar
authors.affiliation: Statistics, Modelling and Economics Department, Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Andrews
authors.affiliation: Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, University College London, 4th Floor Mortimer Market, off Capper Street, London, WC1E 6JB, UK. t.yates@ucl.ac.uk.
authors.forename: Tom A
authors.initials: TA
authors.lastname: Yates
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D009790:Occupations; D012189:Retrospective Studies; D012307:Risk Factors; D014376:Tuberculosis / Q000209:etiology / Q000401:mortality*; D014397:Tuberculosis, Pulmonary / Q000209:etiology / Q000401:mortality; D014852:Wales / Q000453:epidemiology; D017132:Workplace; D055815:Young Adult
keywords: Epidemiology; Historical data; Occupation