Based on the WHO’s Commission on Social Determinants of Health (CSDH), social determinants of health can be divided into structural and intermediary determinants. The economic and social conditions that influence TB risk are collectively known as the social determinants of health. TB disease disproportionately affects poor and marginalised populations and is strongly associated with living or working in an environment with high TB prevalence, overcrowding, poor ventilation, malnutrition and health conditions that impair host immune defence. Īction on poverty and associated risk factors is expected to play an important role in accelerating the decline in TB incidence and has been integrated as a central paradigm of the End TB Strategy. Global estimates updated to reflect disruptions to essential TB services during COVID-19 estimate that TB incidence increased by 3.6% for the first time in decades between 20. However, progress remains well short of what is necessary to achieve these goals. The World Health Organization’s (WHO) End TB Strategy aims to achieve an 80% drop in new cases of TB and 90% reduction in TB mortality by 2030. Tuberculosis (TB) remains the world’s biggest infectious killer, claiming an estimated 1.6 million global deaths in 2021. Here, slowing rising rates of HIV/AIDS and diabetes is likely to accelerate declines in TB incidence. In HUMICs, TB incidence rates remain highest in countries with low human development, health spending and diabetes prevalence, and high rates of HIV/AIDS and alcohol use. Strengthening human development is likely to accelerate declines in TB incidence. In LLMICs, TB incidence rates remain highest in countries with low human development, social protection spending and TB programme performance, and high rates of HIV/AIDS. Within HUMICs, increases in HIV/AIDS and diabetes prevalence over time were associated with higher TB incidence. Between HUMICs, higher HDI, health spending, and diabetes prevalence were associated with lower TB incidence, whereas higher prevalence of HIV/AIDS and alcohol-use were associated with higher TB incidence. Within LLMICs, increases in HDI over time were associated with lower TB incidence rates. Higher prevalence of HIV/AIDS was associated with higher TB incidence. Between LLMICs, higher Human Development Index (HDI), social protection spending, TB case detection, and TB treatment success were associated with lower TB incidence. National TB incidence rates declined in 108/116 countries between 2005–2015, with an average drop of 12.95% in LLMICs and 14.09% in HUMICs. The study sample included 48 low- and lower-middle-income countries (LLMICs) and 68 high- and upper-middle income countries (HUMICs), with a total of 528 and 748 observations between 2005–2015, respectively. The analysis was stratified by country income status. We used multivariable Poisson regression models allowing for distinct within- and between-country effects to estimate associations between national TB incidence rates and 13 social determinants of health. This longitudinal ecological study used country-level data extracted from online databases from the period 2005–2015. The aim of this study was to identify key country-level social determinants of national TB incidence trends. Accelerating declines in tuberculosis (TB) incidence is paramount for achieving global goals set for 2030 by the Sustainable Development Goals and the End TB Strategy.
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