Decline In Tuberculosis Mortality Research Articles

The 1918 influenza pandemic did not accelerate tuberculosis mortality decline in early-20th century Newfoundland: Investigating historical and social explanations.

The selective mortality hypothesis of tuberculosis after the 1918 influenza pandemic, laid out by Noymer and colleagues, suggests that acute exposure or pre-existing infection with tuberculosis (TB) increased the probability of pneumonia and influenza (P&I) mortality during the 1918 influenza pandemic, leading to a hastened decline of TB mortality in post-pandemic years. This study describes cultural determinants of the post-pandemic TB mortality patterns in Newfoundland and evaluates whether there is support for this observation. Death records and historical documents from the Provincial Archives of Newfoundland and Labrador were used to calculate age-standardized island-wide and sex-based TB mortality, as well as region-level TB mortality, for 1900-1939. The Joinpoint Regression Program (version 4.8.0.1) was used to estimate statistically significant changes in mortality rates. Island-wide, females had consistently higher TB mortality for the duration of the study period and a significant shift to lower TB mortality beginning in 1928. There was no similar predicted significant decline for males. On the regional level, no models predicted a significant decline after the 1918 influenza pandemic, except for the West, where significant decline was predicted in the late-1930s. Although there was no significant decline in TB mortality observed immediately post-pandemic, as has been shown for other Western nations, the female post-pandemic pattern suggests a decline much later. The general lack of significant decrease in TB mortality rate is likely due to Newfoundland's poor nutrition and lack of centralized healthcare rather than a biological interaction between P&I and TB.

Glucosylglycerate metabolism, bioversatility and mycobacterial survival.

Despite the progressive decline in tuberculosis mortality, strains resistant to our dated antibiotics remain a global threat, as are the emerging nontuberculous mycobacteria, ubiquitous in natural and human environments. This pressing situation boosted by debilitated immune systems, chronic illness and the aged population calls for efficient strategies to fight these successful organisms, and identifying pathways critical for their survival is a crucial step towards this goal. In this context, the glycoside glucosylglycerate (GG) has been implicated in the adaptation of mycobacteria to nitrogen starvation and to thermal stress, and the key gene for GG synthesis has been considered essential for Mycobacterium tuberculosis growth. The many organisms we now know to have genes for GG metabolism opened new exciting avenues of research into its functions, hinting for example at hypothetical roles as an inter-cellular messenger among bacteria and in microbe-plant interactions, or at key roles in the global nitrogen cycle beyond what cyanobacteria and mycobacteria have taught us so far. Indeed, the insights into GG biology gained over the last decade have changed the perception of GG from a rare polysaccharide constituent to a widespread molecule with multiple functions and biosynthetic origins. It is now possible to build upon this knowledge and further explore its physiological importance in both pathogenic and environmentally relevant microorganisms. In particular, the vital roles of GG and of its important derivative the mycobacterial methylglucose lipopolysaccharide (MGLP) discussed here are now evident, making their metabolic links attractive targets for the development of new urgently needed antimycobacterial therapies.

Information and Disease Prevention: Tuberculosis Dispensaries

Tuberculosis (TB) is a leading cause of death worldwide according to the WHO. This paper estimates the effect of TB dispensaries, designed to prevent the spread of the disease before the advent of modern medicine. Our difference-in-differences estimation reveals that the roll-out of the TB dispensaries across Danish cities led to a 16 percent decline in the TB mortality rate, but no signifficant impacts on other diseases when performing placebo regressions. We obtain very similar estimates from a triple-differences setup, warranting a causal interpretation of our findings. Overall, our conclusion suggests, contrary to McKeown (1976), that public policy played an important role for the decline in TB mortality. It also suggests that dispensaries are of policy relevance for developing countries today as a measure to counter the externalities created by TB and modern drug resistant strains.

Explanations for 20th Century Tuberculosis Decline: How the Public Gets It Wrong

Introduction: Historical analysis of health data indicates that the majority of the decrease in tuberculosis mortality during the past century was caused by improved social conditions and public health interventions. The purpose of this study was to assess lay public perceptions regarding why tuberculosis declined. Materials and Methods: A nationally representative sample of 705 adults was surveyed to identify their perceived reasons for the decline in tuberculosis mortality in the 20th century. Open- ended questions and responses were coded and placed into eight categories. Results: Approximately 52% of decreasing tuberculosis mortality was attributed to “modern medicine,” and 220% to “vaccination.” Comparatively few of the respondents attributed decreased tuberculosis mortality rates to public health or improvements in social health determinants of health. Males gave more credit to modern medicine and public health, with less to vaccination; the other racial group gave more credit to public health and less to modern medicine; Hispanics gave more credit to modern medicine and less to vaccinations; and the higher income groups gave more credit to vaccinations and public health, but less to modern medicine. Conclusion: The public overly attributes modern medicine as the primary cause of declining tuberculosis mortality rates, the second leading cause of death in the United States during the early 1900s, and gives little credit to the critical role played by public health and improved social conditions. These misperceptions may hinder societal efforts to address and fund important social determinants of health and public health interventions.

Year of birth effects in the historical decline of tuberculosis mortality: a reconsideration.

Birth cohort patterns in mortality are often used to infer long-lasting impacts of early life conditions. One of the most widely accepted examples of a birth cohort effect is that of tuberculosis mortality before the late 1940s. However the evidential basis for claims of cohort-specific declines in tuberculosis mortality is very slight. Reanalysis of original or enhanced versions of datasets used previously to support claims of cohort effects in tuberculosis mortality indicated that: 1. where the initial decline in tuberculosis mortality occurred within the period of observation, onset of decline occurred simultaneously in many age groups, in a pattern indicative of ‘period’ not cohort-dependent effects. 2. there was little evidence of ‘proportional hazard’-type cohort patterns in tuberculosis mortality for any female population studied. Therefore any mechanisms proposed to underlie this type of cohort pattern in male mortality must be sex-specific. 3. sex ratios of tuberculosis mortality at older ages peaked in cohorts born around 1900, and resembled cohort sex ratios of lung cancer mortality. This analysis indicates that age-specific patterns in the decline in tuberculosis mortality before 1950 are unlikely to reflect improvements in early life conditions. The patterns observed are generally more consistent with the influence of factors that reduced mortality simultaneously in most age groups. Additional influences, possibly smoking habits, impeded the decline of tuberculosis in older adult males, and produced the sex-specific shifts in age distributions of mortality that were previously interpreted as evidence of cohort-dependent mortality decline.

Estudo dinâmico da mortalidade por tuberculose no Estado de São Paulo, Brasil: uma abordagem bayesiana

This study used dynamic linear models to analyze the dynamics of tuberculosis (TB) mortality in São Paulo State, Brazil. The study confirms previous findings of a decline in TB mortality in State in the last decade, while pointing to an increase in deaths beginning in 2005. Analysis of the two most frequent underlying causes pointed to HIV/TB co-infection. Forecasts for the next two years were performed, providing little evidence to support a continuing downward trend in the number of TB-related deaths.

Resposta brasileira à tuberculose: contexto, desafios e perspectivas

Tuberculosis (TB) has affected mankind for more than 8,000 years. Before the mid-19th century TB was not recognized as a contagious disease and was attributable to several causes such as hereditary, miasmas, and other environmental and social determinants. But, in 1882, Robert Koch identifi ed Mycobacterium tuberculosis, which allowed to defi ning TB as an infectious disease. Then blossoming biomedical research started its quest for vaccines and drug therapies. BCG vaccine was applied for the fi rst time in humans in 1921. Years later, in 1944, streptomycin was successfully used in TB treatment and it was the starting point for a number of anti-TB drug therapies. These breakthroughs created new opportunities for TB prevention and treatment. However, in the 19th century, TB mortality in Europe was remarkably higher than that seen in Africa today. Yet a sharp decline in TB mortality was seen by the end of that century, long before the advent of modern preventive and therapeutic alternatives, most likely due to improved life conditions. Today, in developed countries, TB is a condition confi ned to population groups comprising immigrants from poor countries and other marginalized people (homeless, alcoholics, inmates, among others). Although TB is a potentially curable and preventable disease, it has remained a public health concern in developing countries, including Brazil. Worldwide, it is estimated two billion people have latent TB infection and around 8.8 million new cases are diagnosed every year. In Brazil, about 80,000 cases and 6,000 deaths are reported every year. Owing to its immunosuppressive effect which makes people more susceptible to develop TB, HIV-AIDS epidemic, among other consequences, has contributed to increasing TB cases in many countries. In children, BCG knowingly provides clear protection when given neonatally while, in adults, protection against TB clinical forms is highly variable worldwide, a phenomenon not yet understood. As vaccine is not consistently effective and the major source of TB infection is sick people, the best prevention available in health care is still early detection and treatment of cases. Untreated or inadequately treated cases can infect other people and thus perpetuate TB dissemination chain. TB requires long-term complex treatment with the administration of several drugs for a period of time even after patients have clinically recovered. Treatment default is high and can produce drug-resistant forms of M. tuberculosis, which hinders disease control. The World Health Organization recommends implementation of the directly observed short-course treatment (DOTS) strategy for a fully effective treatment. In Brazil, the successful Family Health Program provides favorable opportunities for expanding access to health care and more effective detection and treatment of diseases such as TB. Starting from 1999, the Brazilian Ministry of Health has set TB as a priority in the health agenda. TB control actions aims at diagnosing at least 90% of expected cases and curing at least 85% of diagnosed cases. The implementation of TB control actions in all municipalities is part of primary health care and local and state administrators are expected to plan and coordinate actions to assure TB control including the implementation of DOTS strategy. Yet this course of action faces great challenges at all levels of health care and social organization: Brazil’s huge territorial area marked by geographical and cultural differences between its regions; inadequately trained providers; lack of research to propose solutions to health care operations; modest involvement of society in TB control; lack of continual regular support to the National Program for Tuberculosis Control; no guarantee of universal, comprehensive and equal access to health care; all in a scenario of huge social inequalities and deprived life conditions of most Brazilian population. TB control is not only an indicator of health care quality but also of social justice. This supplement approaches TB from several different perspectives within the framework of evaluation of the guidelines adopted in Brazil in the last ten years. In the light of all these subjects there is a clear need for the involvement of different actors – civil society, governments and administrators, universities and research centers. By jointly devising effective strategies and thus maximizing the contribution of each segment, within an expected reduction of social inequalities, TB control goals can be attainable in Brazil.

Decline of tuberculosis mortality in an urban Mexican‐origin population, 1935–1984

Through a series of life table analyses, this paper describes the natural history of tuberculosis mortality in a Mexican-origin community over five decades (1935-84) during which the disease underwent a transition from a major underlying cause of death to a disease conditioned mentioned more often on death certificates as contributing to death than causing death. The decline in death rates from 1940 to 1950 was especially remarkable. Successive birth cohorts of Mexican Americans, separated by as little as five years of age, experienced distinctly lower risk of death from tuberculosis as they entered young adulthood. There was a rapid convergence in age-specific patterns of tuberculosis death rates in Mexican Americans toward those of non-Hispanic whites, so that by 1960 tuberculosis was primarily a cause of death in old age rather than young adulthood. The impact of changing environment, both through improvements of conditions within neighborhoods and through residential mobility, on birth cohorts at risk of tuberculosis needs to be examined in further research.

Uses of the Life Table in Public Health

In two of his more recent papers, Spiegelman stressed that it was necessary to examine the experience of generations rather than the cross section of period experience to obtain a better understanding of the underlying changes in mortality with advance in age.l 2 As an example of how current life tables can sometimes present a misleading picture, Spiegelman cited the case of tuberculosis: current life tables pointed to a rise in death rates with advancing age whereas generation experience indicates a decline in tuberculosis mortality at the older ages. The age pattern of generation mortality from specific causes of death can differ significantly from that deduced on the basis of current life tables, depending on the trends in the age-specific death rates. In a broader context Spiegelman observed that the mortality experience of white males in the United States has

The decline of tuberculosis mortality in Western Europe.

The decline of tuberculosis mortality in Western Europe.

Causes of the decline in tuberculosis mortality

Causes of the decline in tuberculosis mortality

Causes of the decline in tuberculosis mortality

Causes of the decline in tuberculosis mortality

The decline of tuberculosis mortality in the United States and the influence of the influenza epidemic of 1918

The decline of tuberculosis mortality in the United States and the influence of the influenza epidemic of 1918