Socio-economic factors that influence tuberculosis death among the youth and middle-aged population: a systematic review

Abstract

The number of tuberculosis (TB) deaths in Japan has decreased by 9% in the past 10 years. As of 2012, the death rate was 1.7 per 100,000 populations. Many studies have reported on the clinical factors associated with the number of TB deaths in Japan, and have identified aging to be a major cause of death among patients with TB. However, death among younger patients with TB is also a serious concern, and although several socio-economic factors have been suggested in the past, these studies have varied in methods and results. Therefore, we conducted a systematic review of previous studies that have focused on the association between TB death and socio-economic factors. Our results revealed unemployment, education, history of homelessness, substance and alcohol abuse, and nationality to be risk factors for TB death. Many of these factors are markers of poverty, and in Japan too, various markers of socio-economic vulnerability have been suggested to have an influence on TB death. These factors negatively affect patients' health-seeking behavior and thereby increase the risk of death. It is therefore necessary to encourage persons at risk of TB to seek early care by collaborating not only with public health and medical institutions, but also with welfare services, employment support services, and alcohol and drug support groups.