Tuberculosis control and economic recession: longitudinal study of data from 21 European countries, 1991–2012

Abstract

ObjectiveTo investigate whether the economic recession affected the control of tuberculosis in the European Union.MethodsMultivariate regression models were used to quantify the association between gross domestic product, public health expenditure and tuberculosis case detection rates, using data from 21 European Union member states (1991–2012). The estimated changes in case detection attributable to the recession were combined with mathematical models of tuberculosis transmission, to project the potential influence of the recession on tuberculosis epidemiology until 2030.FindingsBetween 1991 and 2007, detection rates for sputum-smear-positive tuberculosis in the European Union were stable at approximately 85%. During the economic recession (2008–2011) detection rates declined by a mean of 5.22% (95% confidence interval, CI: 2.54–7.90) but treatment success rates showed no significant change (P = 0.62). A fall in economic output of 100 United States dollars per capita was associated with a 0.22% (95% CI: 0.05–0.39) mean reduction in the tuberculosis case detection rate. An equivalent fall in spending on public health services was associated with a 2.74% (95% CI: 0.31–5.16) mean reduction in the detection rate. Mathematical models suggest that the recession and consequent austerity policies will lead to increases in tuberculosis prevalence and tuberculosis-attributable mortality that are projected to persist for over a decade.ConclusionAcross the European Union, reductions in spending on public health services appear to have reduced tuberculosis case detection and to have increased the long-term risk of a resurgence in the disease.

Cost–effectiveness of screening for active cases of tuberculosis in Flanders, Belgium

“…However, tuberculosis is not often transmitted from migrants to the resident population 39 and WHO’s Regional Office for Europe continues to provide support in response to the migrant and refugee crisis 40 . Possible cuts in public health spending and social protection may also permit increases in tuberculosis incidence and mortality 9 , 41 …”

“…At the same time, economic crises, growing inequity, increases in the incidence of diseases that are risk factors for tuberculosis and the dissemination of drug-resistant forms of Mycobacterium tuberculosis may all be contributing to an expansion in the burden posed by tuberculosis 6 – 9 …”

Tuberculosis inequalities and socio-economic deprivation in Portugal

“…1 Portugal is among the 10 poorest countries of the European Union, and recently underwent a deep economic recession due to the global economic crisis, which led many countries to reduce their support for TB control programmes. 2 Portugal, a country with a medium to low incidence of TB, reached an incidence of 20 per 100 000 population for the first time in 2014, and has one of the highest TB burdens in Europe. 3,4 The scientific and public health communities recognise the fact that to attain the TB targets, including its eradication, it is necessary to expand the scope of TB control beyond the usual efforts by addressing one of the drivers of the epidemic: the socio-economic determinants of health.…”

Fiscal austerity and the health sector: the cost of adjustments

“…Reeves et al 35 analyzed 21 European countries in an attempt to assess the impacts of economic recession on the control of tuberculosis. The authors concluded that reductions in spending on public health services led to reduced tuberculosis case detection and increased long term risk of a resurgence in the disease.…”