Risk factors for pulmonary tuberculosis in Croatia: a matched case–control study
1 Teaching Public Health Institute of Split and Dalmatia County, Vukovarska 46, 21 000 Split, Croatia
2 School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
3 Public Health Institute “Dr Andrija Štampar”, Mirogojska cesta 16, 10000 Zagreb, Croatia
4 Public Health Institute of Osječko-Baranjska County, F. Krežme 1, 31000 Osijek, Croatia
5 Public Health Institute of Istarska County, Nazorova 23, 52100 Pula, Croatia
6 Public Health Institute of Krapinsko-Zagorska County, Ivana Gorana Kovačića 1, 49250 Zlatar, Croatia
7 Public Health Institute of Zadarska County, Kolovare 2, 23000 Zadar, Croatia
8 Croatian National Institute of Public Health, Rockefellerova 7, 10000 Zagreb, Croatia
BMC Public Health 2013, 13:991 doi:10.1186/1471-2458-13-991Published: 21 October 2013
Mycobacterium tuberculosis is a necessary, but not sufficient, cause of tuberculosis. A number of studies have addressed the issue of risk factors for tuberculosis development. Croatia is a European country with an incidence rate of 14/100 000 which is slowly decreasing. The aim of this study is to evaluate the potential demographic, socioeconomic, behavioural and biological risk factors for tuberculosis in Croatia in comparison to other high-income, low-incidence European countries.
A total of 300 tuberculosis patients were matched for age, sex and county of residence to 300 controls randomly selected from general practitioners’ registers. They were interviewed and their medical records were evaluated for variables broadly described as potential risk factors.
In multiple logistic regression, the following factors were significant: parents born in a particular neighbouring county (Bosnia and Herzegovina) (OR = 3.90, 95% CI 2.01-7.58), the lowest level of education (OR = 3.44, 95% CI 1.39-8.50), poor household equipment (OR = 4.72, 95% CI 1.51-14.76), unemployment (OR = 2.69, 95% CI 1.18-6.16), contact with tuberculosis (OR = 2.19, 95% CI 1.27-3.77), former (OR = 2.27, 95% CI 1.19-4.33) and current smoking habits (OR = 2.35, 95% CI 1.27-4.36), diabetes (OR = 2.38, 95% CI 1.05-5.38), a malignant disease (OR = 5.79, 95% CI 1.49-22.42), being underweight in the previous year (OR = 13.57, 95% CI 1.21-152.38).
In our study, the identified risk groups for tuberculosis reflect a complex interaction between socioeconomic conditions, lifestyle and non-communicable diseases. Interventions focused on poverty will undoubtedly be useful, but not sufficient. Tuberculosis control would benefit from a combination of broad public health activities aimed at the prevention and control of risky lifestyles and non-communicable diseases, interventions outside the health sector, and efforts to constantly improve the Croatian national tuberculosis programme.