Thorax. Published Online First: 31 January 2006. doi:10.1136/thx.2005.049452
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Gender differentials of pulmonary tuberculosis transmission and reactivation in an endemic area
1 Instituto Nacional de Salud Pública, Mexico
2 Stanford University, United States
3 Instituto Nacional de Ciencias Medicas y Nutricion, Salvador Zubiran, Mexico
4 Instituto Nacional de Salud de Salud Publica, Mexico
5 Bill & Melinda Gates Foundation, United States
* To whom correspondence should be addressed. E-mail: garcigar{at}correo.insp.mx.
Accepted 23 January 2006
Abstract
Background: In most low-income countries, there are twice as many tuberculosis cases reported among men than among women, a difference commonly attributed to biological and epidemiological characteristics as well as socioeconomic and cultural barriers in access to health care. The World Health Organization (WHO) has encouraged gender-specific comparisons in tuberculosis rates to determine whether women with tuberculosis are less likely than men with tuberculosis to be diagnosed, reported, and treated.
Objective: To identify gender-based differences in pulmonary tuberculosis patients and use this information to improve tuberculosis control efforts.
Methods: We screened persons with more than 2 weeks cough in southern Mexico from March, 1995 to April, 2003. We collected clinical and mycobacteriological information (isolation, identification, drug-susceptibility testing and IS6110-based genotyping and spoligotyping) from individuals with bacteriologically confirmed pulmonary tuberculosis. Patients were treated in accordance with official norms and followed to ascertain treatment outcome, retreatment, and vital status.
Results: We enrolled 623 patients with pulmonary tuberculosis; male:female incidence rate ratio for overall, reactivated and recently transmitted disease was 1.58 (95%CI 1.34 -1.86), 1.64 (95%CI 1.36 - 1.98) and 1.41 (95% CI 1.01 - 1.96), respectively. Men were more likely than women to default from treatment (adjusted OR 3.30, 95%CI 1.46-7.43), to be retreated for tuberculosis (HR 3.15, 95% CI 1.38-7.22), and to die from tuberculosis (HR 2.23, 95%CI 1.25-3.99).
Conclusions: Higher rates of transmitted and reactivated disease and poorer treatment outcomes among men are indicators of gender differentials in pulmonary tuberculosis diagnosis and treatment, and suggest specific strategies in endemic settings.
Keywords: gender, molecular epidemiology, transmission, tuberculosis, women
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