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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 9  |  Issue : 3  |  Page : 251-257

Effect of human development index on tuberculosis incidence in Asia: An ecological study


1 Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
2 School of Public Health, Student Research Committee, Dezful University of Medical Sciences, Dezful, Iran
3 Social Determinants of Health Research Center, School of Allied Medical Sciences, Shahrekord University of Medical Sciences, Shahrekord, Iran
4 Department of Nursing, Gerontological Care Research Center, Bojnurd University of Medical Sciences, Bojnurd, Iran
5 Department of Epidemiology, School of Public Health, Ilam University of Medical Sciences, Ilam, Iran

Date of Web Publication6-Sep-2019

Correspondence Address:
Zaher Khazaei
Department of Epidemiology, School of Public Health, Ilam University of Medical Sciences, Ilam
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AIHB.AIHB_8_19

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  Abstract 


Objective: Tuberculosis (TB) is a global health concern and is one of the main reasons responsible for the death of people by infectious diseases. We conducted this study to investigate the effect of human development index (HDI) on the incidence of TB in Asia. Methods: This ecological study was conducted in Asia to evaluate the correlation between the incidence of TB and HDI (life expectancy at birth, years of education mean and gross national income per capita). Data on TB from 2000 to 2016 were obtained from the World Bank Institution. The bivariate method and regression test were used to evaluate the correlation between incidence and mortality with HDI. Statistical analysis was conducted using Stata-14, and the significance level was considered 0.05. Results: In the recent years, the most occurrence of this disease in Eastern Asia is reported in Democratic Republic of Korea (513 persons/100,000), South-Eastern Asia in Philippines (520–590 persons/100,000), Cambodia (345–575 persons/100,000) and Timor-Leste (498 persons/100,000). A significant negative correlation was found between the incidence of TB and the HDI index in South Eastern (R = −0.609,P < 0.05) and South Central Asia (R = −0.793,P < 0.05). The results of regression analysis indicated that the increase in life expectancy at birth (LBE) (B = −11.45,P < 0.05) and MYS (B = −9.6,P < 0.05) caused a statistically significant decrease in the incidence of TB as well. Conclusion: The incidence of TB has a correlation with the human development index (HDI) in several Asian countries. Therefore, to reduce the incidence of the disease and prevent from it, the human development index should be considered as an effective factor in the occurrence of the disease, particularly in developing countries.

Keywords: Asia, human development index, incidence, tuberculosis


How to cite this article:
Goodarzi E, Sohrabivafa M, Dehkordi AH, Moayed L, Khazaei Z. Effect of human development index on tuberculosis incidence in Asia: An ecological study. Adv Hum Biol 2019;9:251-7

How to cite this URL:
Goodarzi E, Sohrabivafa M, Dehkordi AH, Moayed L, Khazaei Z. Effect of human development index on tuberculosis incidence in Asia: An ecological study. Adv Hum Biol [serial online] 2019 [cited 2019 Dec 11];9:251-7. Available from: http://www.aihbonline.com/text.asp?2019/9/3/251/262892




  Introduction Top


Tuberculosis (TB) is one of the main causes of deaths from infectious diseases in the world. Drug-resistant forms of the bacteria are a major public health concern worldwide. During 2016, 10.4 million new cases of TB were occurred globally.[1],[2] In addition, 600,000 new cases of rifampicin-resistant TB infections were diagnosed during the same year, which 490,000 of them were multidrug-resistant infections (rifampicin is the most effective core drug against TB). Almost half (47%) of the incidents were observed in India, China and the Russian Federation.[3] During 2016, 7.7 million deaths due to TB were reported, of which 4.4 million were people with HIV. TB is seen in all countries and every age groups, but most cases (90%) were reported in adults (2016), and almost two-thirds of the diagnosed patients lived in India, Indonesia, China, Philippines, Pakistan, South Africa and Nigeria. Three regions of WHO, including Southeast Asia (45%), Africa (25%) and the West Pacific (17%) contain circa 87% of TB cases. The European and American regions contain 3% of the total cases, and the Eastern Mediterranean contains 7% of the cases.[4] The annual occurrence of TB was different between the countries in 2016, 10 persons/100,000 population in most countries with high per capita income, up to 150–300 in more than 30 countries with a high occurrence of TB. In addition, more than 500 cases of TB were diagnosed in Democratic People's Republic of Korea, Lesotho, Mozambique, Philippines and South Africa.[5] The most rapid decrease in the incidence of TB (4.6%) was observed in the European region between 2015 and 2016. In addition, there has been a 4% decrease in the incidence of the disease in countries with high-blood pressure issue including Ethiopia, Kenya, Lesotho, Namibia, the Russian Federation, Tanzania, Zambia and Zimbabwe since 2010.[5]

There has been a progress in the care and prevention of TB, which means that the mortality rate (per 100,000 population every year) has decreased by 4.4% and incidence (new cases/100,000 population every year) has decreased by 1.9% annually.[6]

Between 2000 and 2015, national and international efforts have been made to decrease the occurrence of TB based on the millennium development goals. The objective of sustainable development goals (SDGs) is to end the epidemic TB by it reducing its mortality up to 90% and the incidence up to 80% by 2030.[7]

According to the goals of SDGs, the incidence of TB should have been decreased by 1.5% until 2015, 4%–5% by 2020 and 10% by 2025. As well, the mortality rate of TB disease should have been decrease from 17% in 2015 to 10% until 2020, and to 6.5% in 2025.[3]

In the recent years, the reduction of poverty, as well as the progress in the nutrition and the increase in the budget of TB control program, have led to a successful control of the disease.[8] HDI is an affecting factor on TB in different countries. Studies have shown that lower HDI index levels lead to greater incidence and spread of TB due to improper nutritional conditions, infectious diseases, smoking, lack of awareness and poverty.[9],[10] The objective of this study was to investigate the relationship between the incidence of TB and the human development index (HDI) in Asia.


  Methods Top


This ecological descriptive–analytical study was conducted from 2000 to 2016 based on the data from the World Bank on TB.

According to the World Health Organization, the incidence of TB was circa 100,000 in the present year. These data include comorbid HIV-positive and TB patients.[5]

HDI

HDI is a complex of indices in three dimensions – life expectancy, educational level and management of resources for decent living. Today, the global community had notable improvements in all components of HDI. This improvement is different for each country, yet it has led to a reduction of inequities in health care services. Still, there is a major inequality between the northern and southern region in terms of income.[11],[12]

Statistical analysis

In this study, the method of two-dimensional correlation was implemented to evaluate the association between the incidence and mortality rate of TB and HDI. In addition, the linear regression model was used to evaluate HDI in the incidence rate of TB. The significance level was considered 0.05. Data were analysed using STATA 14 Softwar version (Texas, USA).


  Results Top


[Table 1] presents the incidence of TB between 2000 and 2016 in Asia. Studies showed that the highest incidence of TB is reported in Democratic Republic of Korea (513 in 100,000) in Eastern Asia, the Philippines (520–590/100,000) in South-Eastern Asia, Cambodia (345–575/100,000) and Timor-Leste (498/100,000). The highest incidence of TB in 2016 was related to Philippines in South-Eastern Asia with an incidence of 554 per 100,000 and the lowest incidence in Oman in Western Asia with an incidence of 9 per 100,000. [Figure 1].
Table 1: The incidence of tuberculosis in Asia in 2000-2016

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Figure 1: Estimation of tuberculosis incidence, 2016.

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The values for HDI and its dimensions are presented for each Asian country (based on HDI). These countries are classified based on the HDI index as very high, high, moderate and low HDIs [Table 2].
Table 2: Human development index and its components for Asian countries in 2015

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According to [Figure 2], a negative correlation between the incidence of TB and the HDI index was seen in South-Eastern Asia (R = −0.609, P < 0.05) and South-Central Asia (R = −0.793, P < 0.05), which was statistically significant. In addition, a negative correlation was seen between TB and HDI index western Asia, but this correlation was not statistically significant (R = −0.259, P > 0.05) [Figure 2].
Figure 2: Correlation between the human development index and standardized incidence of prostate cancer in Western Asia, South-Central Asia and South-Eastern Asia in 2015.

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The Linear regression model showed that the increase in HDI (B = −0.085, P > 0.05) and gross national income (GNI) (B = 0.006, P > 0.05) caused a decrease in the incidence of TB, but this decrease was not statistically significant (P > 0.05). However, the results from regression analysis showed that the increase in LBE (B = -11.45, P < 0.05) and MYS (B = -9.6, P < 0.05) led to a decrease in the incidence of tuberculosis And this relationship was significant [Table 3].
Table 3: Effects of human developmental indicators Components on the Incidence of tuberculosis in Asia

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  Discussion Top


Studying the incidence of TB requires long-term study plans and large populations (hundreds of thousands), which comes with at a high cost. The best method for estimating the incidence of TB is using the standard global health monitoring and surveillance systems because their reports are accurate. Because of this, these reports can be considered as a close proxy to the incidence rate. However, the monitoring system fails to measure the incidence of TB directly in many countries, because the number of treated patients remains unclear.[13]

The incidence of TB varies in different countries. The lowest incidence is reported in high per capita income countries, including Western Europe, Canada, United States of America, Australia and New Zealand. In these countries, the incidence of TB is < 10/100,000 population. In the South American region, the incidence level of TB is reported to be < 50/100,000 population.[14] Our study results indicated that the highest incidence of TB is seen in the Democratic Republic of Korea (513/100,000) in East Asia, Philippines (520–590/100,000) in South-Eastern Asia, Cambodia (345–575/100,000) and Timor-Leste (498/100,000).

The incidence of TB was relatively stable from 1990 to 2001. Between 2011 and 2012, the reduction rate was 2%. To achieve the goals of millennium development goals (MGD), the reducing trend of TB should have continued until 2015. Using this goal, the incidence of TB has reduced in all six regions of the World Health Organization.[14] One of the most common ways to control TB is to identify the main risk factors for the disease. Recently, the biomedical and behavioural risk factors associated with TB are the main concerns. Pulmonary TB has a positive correlation with poverty and related factors including malnutrition and smoking. Therefore, the incidence of TB is affected by social factors in developing countries.[15],[16]

The results of our study showed that there is a significant negative correlation between the incidence of TB and the HDI index in South-Eastern Asia (R = −0.609, P < 0.05) and South-Central Asia (R = −0.793, P < 0.05). This shows that higher human development index in countries lead to a lower incidence of TB. This matter could be managed by improving the quality of life, correct diagnosis, and treatment of the disease, lack of malnutrition and decreasing poverty.

Investigating social determinants of health can be used to understand the incidence of TB.[17] The Human Development Index (HDI) is a significant factor because it shows the relationship between the incidence of TB and economic dimensions. In addition, it is expressed regarding the quality of life in different countries.[18],[19],[20] Studies in the Asia and Pacific regions showed that HDI is an effective predictor in the incidence of TB.[21],[22],[23] Oxlade et al. used the incidence data of 165 countries and showed that the increase in life expectancy leads to a decrease in the incidence of TB by 7.8/100,000.[24] Other studies reported that increasing HDI leads to the less probability of TB infection; therefore, it can be expected that the increase in HDI and quality of life, as well as improving the awareness and education can reduce the mortality and morbidity of the disease.[20],[25]

During our study, the results of regression analysis showed that the increase in LBE (B = −11.45, P < 0.05) and MYS (B = −9.6, P < 0.05) led to a statically significant reduction in the incidence of TB. In addition, the results of our study showed that the increase in GNI index led to reduction of the incidence of TB, but this reduction was not significant. The income per capita is another important factor in the incidence of TB. Studies have shown that there is a negative relationship between income and the incidence of TB in European countries.[26]

Reviewing the literature has shown that the development of the health system affects the incidence of TB. Implementing the directly observed treatment, short course (DOTS) policy and the stop TB strategy is robustly dependent on the capacity of the health system, the availability of healthcare personnel and infrastructures of the health system.[22],[27] In regions with low HDI levels, the high occurrence of TB is reported due to lack of access to the healthcare system, timely diagnosis and incorrect treatment of the disease.[28]

The results show that the occurrence of TB has a decreasing trend in the world. However, the goal of reducing the rate of the disease below epidemic state is being reached at a slow speed. Implementation of stop TB strategy is accelerated by the World Health Organization, especially regarding the comorbidity of TB and HIV and the efforts to fight them.[3]

Therefore, to ensure the success of TB long-term control program, it is necessary to ensure that all components of the stop TB strategy are implemented precisely, with a specific attention to achieve more access to health care services for developing countries. Improving diagnostic and therapeutic efforts should be combined with prevention programs.

Eventually, newer and more effective vaccines can help the control programmes of TB. In addition, stronger coordination of health organizations to limit the impact of TB risk factors, including HIV/AIDS, smoking, malnutrition, alcohol, diabetes, bad living conditions and air pollution, can significantly reduce the incidence of TB in the world.


  Conclusion Top


The incidence of TB is correlated with human development index (HDI) in Asian countries. Therefore, to reduce the incidence of the disease and achieve the prevention goals, the human development index should be considered as an effective factor in the spread of the disease, particularly in developing countries. According to the results of the study, increasing the life expectancy at birth and the level of education, as well as the awareness of the community, can majorly reduce the incidence of TB.

Acknowledgements

In this study, we used data from the World Health Organization and the World Bank. The study was not financially supported by any grants.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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