Tuberculosis Mortality by Occupation in South Africa, 2011⁻2015.

Tahira Kootbodien,David Rees,Felix Made,Kerry Wilson,Vusi Ntlebi,Nisha Naicker,Nonhlanhla Tlotleng

doi:10.3390/ijerph15122756

Abstract

Work-related tuberculosis (TB) remains a public health concern in low- and middle-income countries. The use of vital registration data for monitoring TB deaths by occupation has been unexplored in South Africa. Using underlying cause of death and occupation data for 2011 to 2015 from Statistics South Africa, age-standardised mortality rates (ASMRs) were calculated for all persons of working age (15 to 64 years) by the direct method using the World Health Organization (WHO) standard population. Multivariate logistic regression analysis was performed to calculate mortality odds ratios (MORs) for occupation groups, adjusting for age, sex, year of death, province of death, and smoking status. Of the 221,058 deaths recorded with occupation data, 13% were due to TB. ASMR for TB mortality decreased from 165.9 to 88.8 per 100,000 population from 2011 to 2015. An increased risk of death by TB was observed among elementary occupations: agricultural labourers (MORadj = 3.58, 95% Confidence Interval (CI) 2.96–4.32), cleaners (MORadj = 3.44, 95% CI 2.91–4.09), and refuse workers (MORadj = 3.41, 95% CI 2.88–4.03); among workers exposed to silica dust (MORadj = 3.37, 95% CI 2.83–4.02); and among skilled agricultural workers (MORadj = 3.31, 95% CI 2.65–4.19). High-risk TB occupations can be identified from mortality data. Therefore, TB prevention and treatment policies should be prioritised in these occupations.

Highlights

South Africa is one of 22 high tuberculosis (TB) burden countries identified by the World HealthOrganization (WHO), with a TB incidence rate of 520 per 100,000 population in 2015 [1]—a decline from a rate of 762 per 100,000 population in 2011 [2]
South Africa, our study aims to understand the patterns associated with occupation and TB mortality by using available occupation information from vital registration data as a mortality surveillance tool to identify occupations at increased risk
We found substantial differences in TB mortality across occupation groups, which may reflect differences in socioeconomic levels, human immunodeficiency virus (HIV)-burden and other risk factors for TB, and occupational exposure to silica dust

Summary

Introduction

South Africa is one of 22 high tuberculosis (TB) burden countries identified by the World Health. Organization (WHO), with a TB incidence rate of 520 per 100,000 population in 2015 [1]—a decline from a rate of 762 per 100,000 population in 2011 [2]. High rates of human immunodeficiency virus (HIV) infection have been a key driver of TB incidence in South Africa, with a reported estimated. There has been a growing burden of multidrug-resistant (MDR). TB (25 per 100,000 population) [4] and the emergence of extensively drug-resistant (XDR) TB in. Many studies have reported that the risk of TB is elevated in health care workers exposed to persons. Res. Public Health 2018, 15, 2756; doi:10.3390/ijerph15122756 www.mdpi.com/journal/ijerph

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