Tuberculosis Infection in Zambia: The Association with Relative Wealth

Delia Boccia Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; ZAMBART Project, Lusaka, Zambia

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James Hargreaves Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; ZAMBART Project, Lusaka, Zambia

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Helen Ayles Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; ZAMBART Project, Lusaka, Zambia

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Katherine Fielding Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; ZAMBART Project, Lusaka, Zambia

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Musonda Simwinga Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; ZAMBART Project, Lusaka, Zambia

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Peter Godfrey-Faussett Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; ZAMBART Project, Lusaka, Zambia

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This study aimed to assess the association between household socioeconomic position and tuberculosis (TB) infection in two communities of Zambia. For this purpose we implemented a cross-sectional investigation, nested within a larger case control study. Infection was assessed using Quantiferon-TB Gold. A socioeconomic position index was constructed through principal component analysis combining data on human resources, food availability, housing quality, and access to services and infrastructures. In this study, higher socioeconomic position, rather than lower, was associated with significantly higher risk of TB infection. None of the traditional risk factors for TB infection mediated this association, suggesting that in these two communities TB transmission may occur through exposure to as yet undefined risk factors that are associated with higher socioeconomic position. Although further studies are needed, these results suggest emerging new patterns of TB transmission and a role of socioeconomic position on the risk of TB infection opposite to that expected.

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