Machiyama, Kazuyo; Semenza, Jan C; Silverwood, RJ; Palmer, Melissa J; Lim, Tek-Ang; Manissero, Davide; Sandgren, Andreas; Ploubidis, George B; (2015) School life expectancy and risk for tuberculosis in Europe. International journal of public health, 61 (5). pp. 603-611. ISSN 1661-8556 DOI: https://doi.org/10.1007/s00038-015-0768-6
Permanent Identifier
Use this Digital Object Identifier when citing or linking to this resource.
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.