Extrinsec determinants of pulmonary tuberculosis

Abstract

Background: Tuberculosis (TB) represents a classic example of an infectious disease linked with the social determinants of the health. The aim of the study is the assessment of social, demographic, economical and hygienic characteristics of patients with pulmonary tuberculosis according to the spectrum of drug-resistance. Material and methods. It was realised a retrospective and selective case-control study of 82 patients with pulmonary TB registered in the Municipal Hospital of TB during the period 1.1.2014 to 1.3.2014. Including criteria in both groups were adult patient (age>18 years), the diagnosis of the new patient with pulmonary TB. Study design consisted in the division of cases in two groups: first group – included 49 drug susceptible TB; second group - 33 MDR-TB cases. Results and discussions. Distributing patients by sex estbalished the predominance of men in comparision with women in both groups: 32 (65.31%) men vs 17 (34.69%) women in 1st group, as well as in the 2nd group 19 (57.57%) vs 14 (42.42%) women, p < 0,001. Patients younger than 44 years prevaled in both groups 39 (79.59%) vs patients older than 44 years 10 (20.41%) in 1st group and 24 (72.72%) cases vs 9(27.27%) cases in the 2nd group, p<0.001. Low educaional level prevaled unsignificant in the 1st group 19 (38.78±6.96%) vs 11 (33.33%) in the 2nd group. Economicaly disadvantaged groups were most prevalent in both samples: 41 (83.67%) in the 1st group vs 26 (78.78%) in the 2nd group; single-civil status prevaled in the 2nd group 18 (54.54%) vs 12 (24.49±6.14%) in the 1st group. Tobacco smokers were two third of the patients: 38(77.55%) in the 1st group and 24 (72.72%) in the 2nd group. Alcohol abusers were 12(24.49%) in the 1st group and 4 (12.12%) in the 2nd group. Lack of health insurance was revealed at 32 (65.31%) cases in the 1st group and 20 (60.61%) patients in the 2nd group.Assessing the type of household was revealed bad conditions in both groups: bad state private appartment owned 24 (48.98%) in the 1st group and 11 (33.33%) cases in 2nd group and old house in bad state 8 (16.32%) in the 1st group and 7 (21.21%) in 2nd group.Multivariate logistic regression model assessing risk factors of drug susceptible/MDR-TB established that risk for developing drug susceptible TB: male sex OR=1.55 (95%CI:0.72-3.32), low educational level OR=4.56 (95%CI: 2.07-10.08); alcohol abuse OR=4.21 (95%CI:1.41-12.54) and for developing MDR-TB age<44 years OR=1.79 (95%CI: 0.78-4.09). Conclusions: social interventions for reducing the risk of TB developing must target all social disadvantaged groups, especially men, young aged individuals, low educated, alcohol abusers.