TY - JOUR

T1 - The impact of living conditions and health interventions on tuberculosis, Denmark, 1876 to 2022

AU - Nordholm, Anne Christine

AU - Joergensen, Anja

AU - Holm, Louise Hedevang

AU - Andersen, Aase Bengaard

AU - Koch, Anders

AU - Andersen, Peter Henrik

AU - Lillebaek, Troels

N1 - Publisher Copyright: © 2024 European Centre for Disease Prevention and Control (ECDC). All rights reserved.

PY - 2024

Y1 - 2024

N2 - Background: Denmark possesses an exceptional historical data collection on tuberculosis (TB) from 1876 to the present, providing a unique opportunity to assess TB epidemiology over 147 years in Denmark. Aim: Our aim was to describe the TB disease burden in Denmark in relation to historical events, living conditions and health interventions during the past 147 years. Methods: We performed a nationwide register-based ecological study including all persons with TB in Denmark from 1876 through 2022, correlating the TB incidence to social, economic and health indicators. Results: In Denmark, the overall TB incidence and mortality declined markedly over the past 147 years, only marginally influenced by specific TB interventions such as sanatoria, Bacillus Calmette-Guèrin (BCG) vaccination, mass screenings and antibiotics. Parallel to this decline, the country experienced improved living conditions, as illustrated by decreased infant mortality and increased life expectancy and wealth. In 1978, Denmark became a low-incidence country for TB with risk groups predominantly affected, and with a continuous change in demographics towards fewer Danish-born cases and relatively more migrant cases. Conclusions: The decline over time in TB incidence and mortality in Denmark preceded specific TB interventions and can, first of all, be attributed to improved living conditions. TB has now become a rare disease in Denmark, predominantly occurring in particular risk groups. Future elimination of TB will require a combination of specific health interventions in these risk groups combined with a continued focus on improving socioeconomic status and living conditions.

AB - Background: Denmark possesses an exceptional historical data collection on tuberculosis (TB) from 1876 to the present, providing a unique opportunity to assess TB epidemiology over 147 years in Denmark. Aim: Our aim was to describe the TB disease burden in Denmark in relation to historical events, living conditions and health interventions during the past 147 years. Methods: We performed a nationwide register-based ecological study including all persons with TB in Denmark from 1876 through 2022, correlating the TB incidence to social, economic and health indicators. Results: In Denmark, the overall TB incidence and mortality declined markedly over the past 147 years, only marginally influenced by specific TB interventions such as sanatoria, Bacillus Calmette-Guèrin (BCG) vaccination, mass screenings and antibiotics. Parallel to this decline, the country experienced improved living conditions, as illustrated by decreased infant mortality and increased life expectancy and wealth. In 1978, Denmark became a low-incidence country for TB with risk groups predominantly affected, and with a continuous change in demographics towards fewer Danish-born cases and relatively more migrant cases. Conclusions: The decline over time in TB incidence and mortality in Denmark preceded specific TB interventions and can, first of all, be attributed to improved living conditions. TB has now become a rare disease in Denmark, predominantly occurring in particular risk groups. Future elimination of TB will require a combination of specific health interventions in these risk groups combined with a continued focus on improving socioeconomic status and living conditions.

U2 - 10.2807/1560-7917.ES.2024.29.24.2300652

DO - 10.2807/1560-7917.ES.2024.29.24.2300652

M3 - Journal article

C2 - 38873798

AN - SCOPUS:85196138012

VL - 29

JO - Eurosurveillance

JF - Eurosurveillance

SN - 1025-496X

IS - 24

M1 - 2300652

ER -