Working conditions and tuberculosis mortality in England and Wales, 1890-1912: a retrospective analysis of routinely collected data.

Charlotte Jackson,Helen R Stagg,Joanna H Mostowy,Nick Andrews,Ibrahim Abubakar,Tom A Yates

doi:10.1186/s12879-016-1509-z

Charlotte Jackson, Helen R Stagg + Show 4 more

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https://doi.org/10.1186/s12879-016-1509-z

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Abstract

BackgroundModelling studies suggest that workplaces may be important sites of Mycobacterium tuberculosis transmission in high burden countries today. Contemporary data on tuberculosis by occupation from these settings are scarce. However, historical data on tuberculosis risk in different occupations are available and may provide insight into workplace transmission. We aimed to ascertain whether, in a high burden setting, individuals working in crowded indoor environments (exposed) had greater tuberculosis mortality than individuals employed elsewhere (unexposed).MethodsThe Registrar General’s Decennial Supplements from 1890–2, 1900–2 and 1910–2 contain data on mortality from tuberculosis by occupation for men in England and Wales. In these data, the association between occupational exposure to crowded indoor environments and tuberculosis mortality was assessed using an overdispersed Poisson regression model adjusting for socioeconomic position, age and decade.ResultsThere were 23,962 deaths from tuberculosis during 14.8 million person-years of follow-up among men working in exposed occupations and 28,483 during 19.9 million person-years of follow-up among men working in unexposed occupations. We were unable to categorise a large number of occupations as exposed or unexposed. The adjusted rate ratio for death from tuberculosis was 1.34 (95 % confidence interval 1.26–1.43) comparing men working in exposed occupations to those in unexposed occupations.ConclusionsTuberculosis mortality in England and Wales at the turn of the 20th century was associated with occupational exposure to crowded indoor environments. The association between working conditions and TB in contemporary high burden settings requires further study.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1509-z) contains supplementary material, which is available to authorized users.

Highlights

Modelling studies suggest that workplaces may be important sites of Mycobacterium tuberculosis transmission in high burden countries today
In high burden settings today, molecular epidemiology suggests that, at least in adults, the majority of Mycobacterium tuberculosis (MTB) transmission occurs outside the home [13,14,15,16]
Incidence is higher in healthcare workers [17] and in miners [18] than in the general population, due to healthcare settings concentrating infectious individuals and the high risk of silicosis, respectively

Summary

Introduction

Modelling studies suggest that workplaces may be important sites of Mycobacterium tuberculosis transmission in high burden countries today. In high burden settings today, molecular epidemiology suggests that, at least in adults, the majority of MTB transmission occurs outside the home [13,14,15,16]. Incidence is higher in healthcare workers [17] and in miners [18] than in the general population, due to healthcare settings concentrating infectious individuals and the high risk of silicosis (which dramatically increases susceptibility to TB), respectively. Mathematical models incorporating data on ventilation and social contact patterns from a high burden informal settlement near Cape Town have suggested that workplaces and public transport may be where most transmission of MTB between adults occurs [20]

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