Impact of socio-economic inequities on tuberculosis in a Southern European city: what is the effect of the recession?

INTRODUCTION: Economic crises affect a population's health, particularly among the most deprived. The increase in health inequalities in the latest recession may have influenced the incidence of tuberculosis (TB). We analysed the effect of socio-economic inequities and recession on TB incidence in Barcelona, Spain. METHODS: We conducted a population-based incidence study of TB cases in Barcelona of patients who started treatment between 2003 and 2015. A multilevel interrupted time-series analysis was performed to analyse differences in incidence trends between the pre-recession (until 2008) and recession periods. RESULTS: We found differences in TB incidence according to deprivation and immigration status. TB incidence among the most deprived neighbourhoods was 2.72 times higher than the least deprived neighbourhoods. Compared with native-born persons, incidence was nine times higher among those born in Africa, and six times higher among those born in Asia and Oceania. The previous decreasing trend in incidence (4%) was accentuated during the recession (7%). CONCLUSIONS: TB incidence decreased during the recession, probably due to a reduction in the number of new immigrants and the TB programme. However, incidence was highly unequal between districts with different levels of deprivation, and between foreign-born persons from different geographic regions. Social measures are important to reduce inequalities and TB incidence in Barcelona.