01 Set SOCIAL DETERMINANTS OF THERAPY FAILURE AND MULTIDRUG RESISTANCE AMONG 407,555 PEOPLE WITH TUBERCOLOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Francesco Di Gennaro
Background: 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 multidrug resistance (MDR). We conducted a meta-analysis investigating the relationship of common social determinants on therapy failure and MDR in people with TB.
Methods: 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).
Results: Fifty studies with 407,555 participants with TB were included. Meta-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, Studies=26, 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.
Interpretation: Low education, low income and alcohol abuse influence therapy failure and MDR in people with tuberculosis. Interventions targeting these social determinants are required to tackle the burden of TB.