Abstract
Social contact patterns might contribute to excess burden of tuberculosis in men. We conducted a study of social contact surveys to evaluate contact patterns relevant to tuberculosis transmission. Available data describe 21 surveys in 17 countries and show profound differences in sex-based and age-based patterns of contact. Adults reported more adult contacts than children. Children preferentially mixed with women in all surveys (median sex assortativity 58%, interquartile range [IQR] 57%–59% for boys, 61% [IQR 60%–63%] for girls). Men and women reported sex-assortative mixing in 80% and 95% of surveys (median sex assortativity 56% [IQR 54%–58%] for men, 59% [IQR 57%–63%] for women). Sex-specific patterns of contact with adults were similar at home and outside the home for children; adults reported greater sex assortativity outside the home in most surveys. Sex assortativity in adult contacts likely contributes to sex disparities in adult tuberculosis burden by amplifying incidence among men.
Highlights
Tuberculosis (TB) is the leading infectious cause of death worldwide; there were an estimated 1.3 million deaths during 2017 [1]
Sex-specific social contact patterns might be useful in understanding TB in women and children, as shown by analytical results suggesting most new M. tuberculosis infections among men, women, and children in South Africa and Zambia can be attributed to contact with men [10]
The main finding of this systematic review and metaanalysis of 21 social contact surveys in 17 countries is that sex differences in social contact patterns are profound, to an extent likely to be amplifying sex disparities in the adult burden of TB in many settings
Summary
Tuberculosis (TB) is the leading infectious cause of death worldwide; there were an estimated 1.3 million deaths during 2017 [1]. The impact is apparent from recent prevalence surveys of undiagnosed TB, which offer the most accurate measure of disease burden [1] and confirm pronounced sex disparity; men account for 70% of infectious cases in the community [5]. Data from social contact surveys provide insight into how individual behaviors drive disease dynamics at the population level [11], providing better predictions of patterns of infection for respiratory pathogens [12,13] than can be made from assumptions of homogenous or proportionate mixing [14]. A few analyses have assessed the sex assortativity of contacts in sufficient detail to provide major insights into the transmission potential for diseases with major sex disparities, such as TB [10,15,16]
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