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01.12.2016 | Research article | Ausgabe 1/2016 Open Access

BMC Infectious Diseases 1/2016

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

Zeitschrift:
BMC Infectious Diseases > Ausgabe 1/2016
Autoren:
Charlotte Jackson, Joanna H. Mostowy, Helen R. Stagg, Ibrahim Abubakar, Nick Andrews, Tom A. Yates
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12879-016-1509-z) contains supplementary material, which is available to authorized users.
The authors wish it to be known that, in their opinion, CJ and JHM should be regarded as joint first authors

Competing interests

All authors declare no conflicts of interest relevant to this manuscript. CJ and HRS have undertaken paid consultancy work for Otsuka Pharmaceutical. HRS has received money for travel and subsistence from Otsuka Pharmaceutical. TAY has worked on studies that received support from GSK and Pasante but did not benefit financially from these arrangements. HRS, IA and TAY are involved in a study that uses medicine donated by Sanofi.

Authors’ contributions

TAY conceived the analysis. JHM extracted the data, with checks from CJ. JHM, CJ, HRS, TAY and NJA analysed the data. JHM drafted the manuscript. CJ, JHM, HRS, IA, NA and TAY all commented on and edited the manuscript. All authors read and approved the final manuscript.

Abstract

Background

Modelling 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).

Methods

The 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.

Results

There 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.

Conclusions

Tuberculosis 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.
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