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.

Anna Scotti
annascotti@mattioli1885.com
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