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      Tuberculosis Mortality and Living Conditions in Bern, Switzerland, 1856-1950

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          Abstract

          Background

          Tuberculosis (TB) is a poverty-related disease that is associated with poor living conditions. We studied TB mortality and living conditions in Bern between 1856 and 1950.

          Methods

          We analysed cause-specific mortality based on mortality registers certified by autopsies, and public health reports 1856 to 1950 from the city council of Bern.

          Results

          TB mortality was higher in the Black Quarter (550 per 100,000) and in the city centre (327 per 100,000), compared to the outskirts (209 per 100,000 in 1911–1915). TB mortality correlated positively with the number of persons per room (r = 0.69, p = 0.026), the percentage of rooms without sunlight (r = 0.72, p = 0.020), and negatively with the number of windows per apartment (r = -0.79, p = 0.007). TB mortality decreased 10-fold from 330 per 100,000 in 1856 to 33 per 100,000 in 1950, as housing conditions improved, indoor crowding decreased, and open-air schools, sanatoria, systematic tuberculin skin testing of school children and chest radiography screening were introduced.

          Conclusions

          Improved living conditions and public health measures may have contributed to the massive decline of the TB epidemic in the city of Bern even before effective antibiotic treatment became finally available in the 1950s.

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          Most cited references 15

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          Tuberculosis and poverty.

          To examine whether the historical link between tuberculosis and poverty still exists. Retrospective study examining the notifications of all forms of tuberculosis by council ward over a six year period and correlating this with four indices of poverty; council housing, free school meals, the Townsend overall deprivation index, and the Jarman index. The 33 electoral wards of the city of Liverpool. 344 residents of Liverpool with tuberculosis. The rate of tuberculosis was correlated with all measures of poverty, the strongest correlation being with the Jarman index (r = 0.73, p < 0.0001). This link was independent of the high rates of tuberculosis seen in ethnic minorities. Tuberculosis remains strongly associated with poverty.
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            The Relationship between Tuberculosis and Influenza Death during the Influenza (H1N1) Pandemic from 1918-19

            The epidemiological mechanisms behind the W-shaped age-specific influenza mortality during the Spanish influenza (H1N1) pandemic 1918-19 have yet to be fully clarified. The present study aimed to develop a formal hypothesis: tuberculosis (TB) was associated with the W-shaped influenza mortality from 1918-19. Three pieces of epidemiological information were assessed: (i) the epidemic records containing the age-specific numbers of cases and deaths of influenza from 1918-19, (ii) an outbreak record of influenza in a Swiss TB sanatorium during the pandemic, and (iii) the age-dependent TB mortality over time in the early 20th century. Analyzing the data (i), we found that the W-shaped pattern was not only seen in mortality but also in the age-specific case fatality ratio, suggesting the presence of underlying age-specific risk factor(s) of influenza death among young adults. From the data (ii), TB was shown to be associated with influenza death (P = 0.09), and there was no influenza death among non-TB controls. The data (iii) were analyzed by employing the age-period-cohort model, revealing harvesting effect in the period function of TB mortality shortly after the 1918-19 pandemic. These findings suggest that it is worthwhile to further explore the role of TB in characterizing the age-specific risk of influenza death.
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              The intrinsic transmission dynamics of tuberculosis epidemics.

              In developed countries the major tuberculosis epidemics declined long before the disease became curable in the 1940s. We present a theoretical framework for assessing the intrinsic transmission dynamics of tuberculosis. We demonstrate that it takes one to several hundred years for a tuberculosis epidemic to rise, fall and reach a stable endemic level. Our results suggest that some of the decline of tuberculosis is simply due to the natural behaviour of an epidemic. Although other factors must also have contributed to the decline, these causal factors were constrained to operate within the slow response time dictated by the intrinsic dynamics.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                16 February 2016
                2016
                : 11
                : 2
                Affiliations
                [1 ]Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
                [2 ]Swiss Tropical and Public Health Institute, Basel, Switzerland
                [3 ]University of Basel, Basel, Switzerland
                [4 ]Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
                Johns Hopkins Bloomberg School of Public Health, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: KZ ME LF. Analyzed the data: KZ MB MZ. Contributed reagents/materials/analysis tools: KZ MB MZ HLR ME LF. Wrote the paper: KZ MB MZ HLR ME LF.

                Article
                PONE-D-15-55271
                10.1371/journal.pone.0149195
                4755532
                26881850
                © 2016 Zürcher et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 4, Tables: 1, Pages: 11
                Product
                Funding
                The authors have no support or funding to report.
                Categories
                Research Article
                Medicine and Health Sciences
                Infectious Diseases
                Bacterial Diseases
                Tuberculosis
                Medicine and Health Sciences
                Tropical Diseases
                Tuberculosis
                People and Places
                Demography
                Death Rates
                Biology and Life Sciences
                Population Biology
                Population Metrics
                Death Rates
                People and Places
                Geographical Locations
                Europe
                Switzerland
                Medicine and Health Sciences
                Public and Occupational Health
                People and Places
                Population Groupings
                Age Groups
                Infants
                Medicine and Health Sciences
                Infectious Diseases
                Medicine and Health Sciences
                Infectious Diseases
                Bacterial Diseases
                Typhoid
                Social Sciences
                Sociology
                Education
                Schools
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

                Uncategorized

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