Kazuyo Machiyama1, Jan C Semenza2, R J Silverwood1, Melissa J Palmer1, Tek-Ang Lim3, Davide Manissero3, Andreas Sandgren3, George B Ploubidis4. 1. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. 2. European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11A, 171 82, Stockholm, Sweden. jan.semenza@ecdc.europa.eu. 3. European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11A, 171 82, Stockholm, Sweden. 4. Department of Social Science, Centre for Longitudinal Studies, UCL - Institute of Education, University College London, 55-59 Gordon Square, London, WC1H 0NU, UK.
Abstract
OBJECTIVE: This study aims to investigate the effect of country-level school life expectancy on Tuberculosis (TB) incidence to gain further understanding of substantial variation in TB incidence across Europe. METHODS: An ecological study examined the prospective association between baseline country-level education in 2000 measured by school life expectancy and TB incidence in 2000-2010 in 40 countries of the WHO European region using quantile regression. Subsequently, to validate the ecological associations between education and TB incidence, an individual-level analysis was performed using case-based data in 29 EU/EEA countries from the European Surveillance System (TESSy) and simulating a theoretical control group. RESULTS: The ecological analysis showed that baseline school life expectancy had a negative prospective association with TB incidence. We observed consistent negative effects of school life expectancy on individuals' TB infections prospectively. CONCLUSIONS: These findings suggests that country-level education is an important determinant of individual-level TB infection in the region, and in the absence of a social determinants indicator that is routinely collected for reportable infectious diseases, the adoption of country-level education for reportable infectious diseases would significantly advance the field.
OBJECTIVE: This study aims to investigate the effect of country-level school life expectancy on Tuberculosis (TB) incidence to gain further understanding of substantial variation in TB incidence across Europe. METHODS: An ecological study examined the prospective association between baseline country-level education in 2000 measured by school life expectancy and TB incidence in 2000-2010 in 40 countries of the WHO European region using quantile regression. Subsequently, to validate the ecological associations between education and TB incidence, an individual-level analysis was performed using case-based data in 29 EU/EEA countries from the European Surveillance System (TESSy) and simulating a theoretical control group. RESULTS: The ecological analysis showed that baseline school life expectancy had a negative prospective association with TB incidence. We observed consistent negative effects of school life expectancy on individuals' TB infections prospectively. CONCLUSIONS: These findings suggests that country-level education is an important determinant of individual-level TB infection in the region, and in the absence of a social determinants indicator that is routinely collected for reportable infectious diseases, the adoption of country-level education for reportable infectious diseases would significantly advance the field.
Entities:
Keywords:
Education; Epidemiology; Europe; Social determinants of health; Tuberculosis
Authors: George B Ploubidis; Melissa J Palmer; Charlotte Blackmore; Tek-Ang Lim; Davide Manissero; Andreas Sandgren; Jan C Semenza Journal: Eur Respir J Date: 2012-01-20 Impact factor: 16.671
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