Socioeconomic Determinants of Tuberculosis Cases in Indonesia, 2010–2013: An Ecological Study

Abstract

BACKGROUND: Indonesia encounters a serious issue of disparity in tuberculosis cases among provinces.  These disparities are crucial since they may reflect a macro-level factor that could be modified to further reduce the cases. Some factors are identified contributing to this variation, including socioeconomic determinants. AIM: This study investigated whether these socioeconomic determinants (i.e., poverty, unemployment, income inequality, and low education) can predict the variation of tuberculosis cases across provinces in Indonesia. METHODS: We conducted an ecological analysis by using public-use data files of the Annual Indonesian Health Profile Report and The Indonesian Social and Population Profile Report consisting of data from 33 provinces, 2010–2013. The main outcome measures were province-level tuberculosis notification cases for all form of tuberculosis cases and new smear-positive cases. The correlation between socioeconomic determinants and tuberculosis notification cases was analyzed with bivariate analyses and multivariate linear regression analyses. RESULTS: This study showed that poverty was strongly and positively correlated with tuberculosis notification cases, either all form or new smear-positive cases. Unemployment was also positively correlated with tuberculosis notification cases, but the power was lower. In contrast, income inequality and low education level were not statistically correlated with tuberculosis notification cases. In multivariate linear regression analyses, poverty is the strongest predictor for tuberculosis notification cases. Poverty had a bigger impact than unemployment in the increased tuberculosis notification cases. CONCLUSION: Findings from this study suggest that poverty has a profound influence on the variation for tuberculosis notification cases across provinces in Indonesia.