title: Social determinants of therapy failure and multi drug resistance among people with tuberculosis: A review.
abstract: Social determinants influence health and the development of tuberculosis (TB). However, a paucity of data is available considering the relationship of social determinants influencing therapy failure and multi drug resistance (MDR). We conducted a review investigating the relationship of common social determinants on therapy failure and MDR in people with TB.
  
  
  
  PubMed and SCOPUS were searched without language restrictions until February 02, 2016 for studies reporting the association between socioeconomic factors (income, education and alcohol abuse) and therapy failure or MDR-TB. The association between social determinants and outcomes was explored by pooling data with a random effects model and calculating crude and adjusted odds ratios (ORs) ±95% confidence intervals (CIs).
  
  
  
  Fifty studies with 407,555 participants with TB were included. Analysis demonstrated that low income (unadjusted OR = 2.00 (95% CI: 1.69-2.38; I2= 88%; 33 studies, adjusted OR 1.77, p < 0.0001), low education (unadjusted OR 2.11, 95% CI 1.55-2.86, 26 studies, adjusted OR 1.69, p < 0.0001) and alcohol abuse (unadjusted OR = 2.43 (95% CI: 1.56-3.80, 16 studies, adjusted OR 2.13, p < 0.0001) were associated with therapy failure. Similarly, low income (unadjusted OR = 1.67; 95% CI: 1.12-2.41, p = 0.006; 14 studies, adjusted OR 2.16, p < 0.0001) and alcohol abuse (unadjusted OR = 1.88; 95% CI: 1.18-3.00, 7 studies, adjusted OR 1.43, p = 0.06) were associated with MDR-TB. Increasing age of the population was able to explain a consistent part of the heterogeneity found.
authors.affiliation: Clinic of Infectious Diseases, University of Bari, Bari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Gennaro
authors.affiliation: Operational Research Unit, Doctors with Africa Cuamm, Beira, Mozambique. Electronic address: d.pizzol@cuamm.org.
authors.forename: Damiano
authors.initials: D
authors.lastname: Pizzol
authors.affiliation: Scientific Direction, Central Hospital of Beira, Mozambique.
authors.forename: Bonifacio
authors.initials: B
authors.lastname: Cebola
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK; South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Brendon
authors.initials: B
authors.lastname: Stubbs
authors.affiliation: Clinic of Infectious Diseases, University of Bari, Bari, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Monno
authors.affiliation: Clinic of Infectious Diseases, University of Bari, Bari, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Saracino
authors.affiliation: Department of Pathology and Diagnostics, Verona University and Hospital Trust, Verona, Italy; Azienda Provinciale per i Servizi Sanitari (APSS) Trento, Trento, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Luchini
authors.affiliation: Department of Neurosciences, University of Padova, Italy; Local Health Unit (ULSS) 17, Mental Health Department, Monselice, Padova, Italy; Institute for Clinical Research and Education in Medicine (IREM), Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Solmi
authors.affiliation: Operational Research Unit, Doctors with Africa Cuamm, Padova, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Segafredo
authors.affiliation: Operational Research Unit, Doctors with Africa Cuamm, Padova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Putoto
authors.affiliation: Institute for Clinical Research and Education in Medicine (IREM), Padova, Italy; Department of Medicine (DIMED)-Geriatrics Section, University of Padova, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Veronese
mesh_terms: D000328:Adult; D000367:Age Factors; D000437:Alcoholism / Q000453:epidemiology; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D024901:Drug Resistance, Multiple, Bacterial; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000472:pathogenicity; D016017:Odds Ratio; D012307:Risk Factors; D064890:Social Determinants of Health; D017211:Treatment Failure; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents
keywords: Multi-drug resistance; Social determinants; Tuberculosis