Socioeconomic deprivation and tuberculosis in Germany: a longitudinal spatial analysis (2001–2022)

Abstract Background Socioeconomic conditions may affect tuberculosis (TB) dynamics. We analyzed the relation between area-level socioeconomic deprivation and TB incidence in Germany between 2001-2022. Methods Using nationally representative data at the level of 400 German districts, we fitted generalized linear mixed models to assess the effect of socioeconomic deprivation on TB incidence controlling for age, sex, share of non-nationals population, share of refugees, geographic effects, location and time. We estimated crude and adjusted risk ratios (RR) and corresponding 95% Confidence Intervals (95%-CI) for socioeconomic deprivation quintiles (Q1-Q5), ranging from least (Q1) to most deprived (Q5) districts. Results Preliminary findings show that crude TB incidence risk was 7% higher (RR = 1.07, 95%-CI=1.04-1.09) in least (Q1) compared to most deprived areas (Q5). Districts with medium-low (Q2), medium (Q3), and medium-high (Q4) socioeconomic deprivation showed 1% higher (1.01, 0.98-1.03), 4% lower (0.96, 0.94-0.99) and 3% lower (0.97 0.94-1.00) risk, respectively, compared to the most deprived districts (Q5). Fully adjusted incidence risk was 6% lower for Q1 compared to Q5 (0.94, 0.86-1.02), while districts classified in quintiles Q2-Q4 showed 8% (0.92, 0.86-0.99), 6% (0.94, 0.88-1.01) and 3% (0.97, 0.92-1.02) lower risk compared to Q5, respectively. Conclusions The adjusted effect of area-level socioeconomic deprivation on the risk of TB incidence has been low in Germany. Not considering the assumed confounders leads to over-estimation of the association between area-level SES and TB. Future studies should explore further area-level or individual factors in order to better understand the spatial variation of TB incidence in Germany. Key messages • Area-level socioeconomic deprivation has a low effect on the risk of TB incidence across German districts. • Further research is needed in order to better understand the spatial variation of TB incidence in Germany.