Tuberculosis associated with household crowding in a developed country

Background: Tuberculosis ( TB) remains an important infectious disease in New Zealand ( NZ) and globally, but risk factors for transmission are still poorly understood. This research aimed to identify whether household crowding contributes to TB transmission in NZ. Methods: This ecological study used TB surveillance and census data to calculate TB incidence rates by census area unit (CAU). Census data were used to determine CAU characteristics including proportion of household crowding ( a bedroom deficit of one or more), proportion of population who are migrants born in high-TB-incidence countries, median household income, and deprivation level. A negative binomial regression model was used to estimate the association between TB incidence and household crowding. Results: The analysis included 1898 notified TB cases for the 2000-4 period. Univariate analysis showed TB incidence at the CAU level was associated with household crowding, for the total population and for all ethnic and age groups. After adjusting for the covariates of household income, existing TB burden, and proportion of migrants from high-TB-incidence countries, multivariate analysis showed statistically significant associations between TB incidence and household crowding. The incidence rate ratio (IRR) was 1.05 ( 95% CI 1.02 to 1.08) in the total population and 1.08 ( 95% CI 1.04 to 1.12) for NZ-born people < 40 years. Conclusion: At the CAU level, TB incidence in NZ is associated with household crowding. An individual-based study ( e. g. case-control) in recently infected cases ( detected by molecular epidemiology techniques) is suggested to complement these findings. Reducing or eliminating household crowding could decrease TB incidence in NZ and globally.