Document Detail

Mass incarceration can explain population increases in TB and multidrug-resistant TB in European and central Asian countries.
MedLine Citation:
PMID:  18728189     Owner:  NLM     Status:  MEDLINE    
Several microlevel studies have pinpointed prisons as an important site for tuberculosis (TB) and multidrug-resistant TB in European and central Asian countries. To date, no comparative analyses have examined whether rises in incarceration rates can account for puzzling differences in TB trends among overall populations. Using longitudinal TB and cross-sectional multidrug-resistant TB data for 26 eastern European and central Asian countries, we examined whether and to what degree increases in incarceration account for differences in population TB and multidrug-resistant TB burdens. We find that each percentage point increase in incarceration rates relates to an increased TB incidence of 0.34% (population attributable risk, 95% C.I.: 0.10-0.58%, P < 0.01), after controlling for TB infrastructure; HIV prevalence; and several surveillance, economic, demographic, and political indicators. Net increases in incarceration account for a 20.5% increase in TB incidence or nearly three-fifths of the average total increase in TB incidence in the countries studied from 1991 to 2002. Although the number of prisoners is a significant determinant of differences in TB incidence and multidrug-resistant TB prevalence among countries, the rate of prison growth is a larger determinant of these outcomes, and its effect is exacerbated but not confounded by HIV. Differences in incarceration rates are a major determinant of differences in population TB outcomes among eastern European and central Asian countries, and treatment expansion alone does not appear to resolve the effect of mass incarceration on TB incidence.
David Stuckler; Sanjay Basu; Martin McKee; Lawrence King
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2008-08-26
Journal Detail:
Title:  Proceedings of the National Academy of Sciences of the United States of America     Volume:  105     ISSN:  1091-6490     ISO Abbreviation:  Proc. Natl. Acad. Sci. U.S.A.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-09-10     Completed Date:  2008-09-30     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  7505876     Medline TA:  Proc Natl Acad Sci U S A     Country:  United States    
Other Details:
Languages:  eng     Pagination:  13280-5     Citation Subset:  IM    
Department of Sociology, Faculty of Social and Political Sciences, University of Cambridge, Free School Lane, Cambridge CB2 1ST, United Kingdom.
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MeSH Terms
Antitubercular Agents / pharmacology,  therapeutic use*
Asia, Central / epidemiology
Cross-Sectional Studies
Europe / epidemiology
Mycobacterium / drug effects,  isolation & purification,  physiology
Prisoners / statistics & numerical data*
Time Factors
Tuberculosis / drug therapy*,  epidemiology*,  microbiology
Tuberculosis, Multidrug-Resistant / epidemiology*
Grant Support
R36//PHS HHS; T32//PHS HHS; //Wellcome Trust
Reg. No./Substance:
0/Antitubercular Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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