The 81st Annual Meeting of the American Association of Physical Anthropologists (2012)


Education and marital status are protective against active tuberculosis in Monterrey, Mexico

BONNIE N. YOUNG1, ADRIAN RENDON2, ADRIAN ROSAS-TARACO3, ALEXIS HANDAL4, JACK BAKER5, JEFFREY LONG1, MARCOS BURGOS6 and KEITH HUNLEY1.

1Anthropology, University of New Mexico, 2Hospital Jose E. Gonzalez, Universidad Autonoma de Nuevo Leon, 3Immunology, Universidad Autonoma de Nuevo Leon, 4Family and Community Medicine, University of New Mexico, 5Geospatial and Population Studies, University of New Mexico, 6Internal Medicine, University of New Mexico

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The Monterrey Metropolitan Area (MMA) has almost double the rate of pulmonary tuberculosis (TB) compared to the Mexican national average, despite high wealth, education, employment, and living conditions. Given this unique setting, we explored predictors of active TB through a multilevel approach of individual, household, and social measures. A case-control study was performed during January-July 2010 at the University Hospital “Jose Gonzalez” in Monterrey, Mexico. Cases (n=97) had laboratory confirmation of active pulmonary TB and controls (n=40) had skin test confirmation of latent TB infection. Socio-demographic, health, housing, and lifestyle variables were collected through in-depth interviews and medical records. Mean participant age was 43.8 years (± 15.9), and 56.9% of the sample was male. Most participants were non-indigenous (79.6%), non-professional or never employed (67.9%), and low to middle socioeconomic status (71.6%). Unadjusted analysis showed that active TB was significantly associated with marital status, education, and principal lifetime employment. Adjusting for all potential risk factors using backward selection multivariable logistic regression, we found a protective effect of education (OR 0.59, 95% CI 0.40, 0.88) and marital status (OR 0.36, 95% CI 0.16, 0.81) against active TB. The results indicate that education is an important determinant of health, even in a relatively wealthy region. Consistent with other studies, spousal support is recognized for its association with health, independent of socioeconomic factors. Its protective effect has been related to psychological health, healthcare access, and latent TB treatment completion. This research highlights multilevel factors of active TB risk with implications for prevention in Mexico.

This work was generously funded by the Wenner-Gren Foundation for Anthropological Research and the following entities at the University of New Mexico: Department of Anthropology, Latin American & Iberian Institute, Office of Graduate Studies, and the Institute of Public Health.

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