{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T20:40:08Z","timestamp":1794429608097,"version":"4.9.1"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,3,27]],"date-time":"2020-03-27T00:00:00Z","timestamp":1585267200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,3,27]],"date-time":"2020-03-27T00:00:00Z","timestamp":1585267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000664","name":"DH | NIHR | Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["08\/17\/01"],"award-info":[{"award-number":["08\/17\/01"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000664","name":"DH | NIHR | Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["08\/17\/01"],"award-info":[{"award-number":["08\/17\/01"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000664","name":"DH | NIHR | Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["08\/17\/01"],"award-info":[{"award-number":["08\/17\/01"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Addressing social determinants of tuberculosis (TB) is essential to achieve elimination, including in low-incidence settings. We measured the association between socio-economic status and intermediate social determinants of health (SDHs,\u00a0including drug misuse, tobacco smoking and alcohol), and TB, taking into account their clustering in individuals. We conducted a case-control study in 23\u201338 years old UK-born White adults with first tuberculosis episode, and randomly selected age and sex frequency-matched community controls. Data was collected on education, household overcrowding, tobacco smoking, alcohol and drugs use, and history of homelessness and prison. Analyses were done using logistic regression models, informed by a formal theoretical causal framework (Directed Acyclic Graph). 681 TB cases and 1183 controls were recruited. Tuberculosis odds were four times higher in subjects with education below GCSE O-levels, compared to higher education (OR\u2009=\u20093.94; 95%CI: 2.74, 5.67), after adjusting for other TB risk factors (age, sex, BCG-vaccination and stays \u22653 months in Africa\/Asia). When simultaneously accounting for respective SDHs, higher tuberculosis risk was independently associated with tobacco smoking, drugs use (especially injectable drugs OR\u2009=\u20095.67; 95%CI: 2.68, 11.98), homelessness and area-level deprivation. Population Attributable Fraction estimates suggested that tobacco and class-A drug use were, respectively, responsible for 18% and 15% of TB cases in this group. Our findings suggest that socio-economic deprivation remains a driver of tuberculosis in England, including through drugs misuse, tobacco smoking, and homelessness. These findings further support the integration of health and social services in high-risk young adults to improve TB control efforts.<\/jats:p>","DOI":"10.1038\/s41598-020-62667-8","type":"journal-article","created":{"date-parts":[[2020,3,27]],"date-time":"2020-03-27T11:03:21Z","timestamp":1585307001000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Drug misuse, tobacco smoking, alcohol and other social determinants of tuberculosis in UK-born adults in England: a community-based case-control study"],"prefix":"10.1038","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3429-0259","authenticated-orcid":false,"given":"Patrick","family":"Nguipdop-Djomo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura C.","family":"Rodrigues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0370-1430","authenticated-orcid":false,"given":"Ibrahim","family":"Abubakar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Punam","family":"Mangtani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,3,27]]},"reference":[{"key":"62667_CR1","unstructured":"World Health Organization. Global tuberculosis report 2015 - 20th Edition 2015. Available from, http:\/\/apps.who.int\/iris\/bitstream\/10665\/191102\/1\/9789241565059_eng.pdf?ua=1."},{"issue":"12","key":"62667_CR2","doi-asserted-by":"publisher","first-page":"2240","DOI":"10.1016\/j.socscimed.2009.03.041","volume":"68","author":"K Lonnroth","year":"2009","unstructured":"Lonnroth, K., Jaramillo, E., Williams, B. G., Dye, C. & Raviglione, M. Drivers of tuberculosis epidemics: the role of risk factors and social determinants. Soc. Sci. Med. 68(12), 2240\u20136, https:\/\/doi.org\/10.1016\/j.socscimed.2009.03.041 (2009).","journal-title":"Soc. Sci. Med."},{"issue":"9346","key":"62667_CR3","doi-asserted-by":"publisher","first-page":"1640","DOI":"10.1016\/S0140-6736(02)11602-3","volume":"360","author":"R Poulton","year":"2002","unstructured":"Poulton, R. et al. Association between children\u2019s experience of socioeconomic disadvantage and adult health: a life-course study. Lancet. 360(9346), 1640\u20135, https:\/\/doi.org\/10.1016\/S0140-6736(02)11602-3 (2002).","journal-title":"Lancet."},{"issue":"3","key":"62667_CR4","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1016\/j.drugalcdep.2008.01.014","volume":"95","author":"TM Caldwell","year":"2008","unstructured":"Caldwell, T. M. et al. Lifecourse socioeconomic predictors of midlife drinking patterns, problems and abstention: findings from the 1958 British Birth Cohort Study. Drug. Alcohol. Depend. 95(3), 269\u201378, https:\/\/doi.org\/10.1016\/j.drugalcdep.2008.01.014 (2008).","journal-title":"Drug. Alcohol. Depend."},{"key":"62667_CR5","doi-asserted-by":"publisher","unstructured":"Casetta, B. et al. Association between cigarette smoking prevalence and income level: a systematic review and meta-analysis. Nicotine Tob Res., https:\/\/doi.org\/10.1093\/ntr\/ntw266 (2016).","DOI":"10.1093\/ntr\/ntw266"},{"issue":"9728","key":"62667_CR6","doi-asserted-by":"publisher","first-page":"1814","DOI":"10.1016\/S0140-6736(10)60483-7","volume":"375","author":"K Lonnroth","year":"2010","unstructured":"Lonnroth, K. et al. Tuberculosis control and elimination 2010-50: cure, care, and social development. Lancet. 375(9728), 1814\u201329, https:\/\/doi.org\/10.1016\/S0140-6736(10)60483-7 (2010).","journal-title":"Lancet."},{"issue":"9979","key":"62667_CR7","doi-asserted-by":"publisher","first-page":"1799","DOI":"10.1016\/S0140-6736(15)60570-0","volume":"385","author":"M Uplekar","year":"2015","unstructured":"Uplekar, M. et al. WHO\u2019s new end TB strategy. Lancet. 385(9979), 1799\u2013801, https:\/\/doi.org\/10.1016\/S0140-6736(15)60570-0 (2015).","journal-title":"Lancet."},{"issue":"4","key":"62667_CR8","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1183\/09031936.00214014","volume":"45","author":"K Lonnroth","year":"2015","unstructured":"Lonnroth, K. et al. Towards tuberculosis elimination: an action framework for low-incidence countries. Eur. Respir. J. 45(4), 928\u201352, https:\/\/doi.org\/10.1183\/09031936.00214014 (2015).","journal-title":"Eur. Respir. J."},{"issue":"2","key":"62667_CR9","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1093\/oxfordjournals.epirev.a000807","volume":"23","author":"C Lienhardt","year":"2001","unstructured":"Lienhardt, C. From exposure to disease: the role of environmental factors in susceptibility to and development of tuberculosis. Epidemiol. Rev. 23(2), 288\u2013301 (2001).","journal-title":"Epidemiol. Rev."},{"key":"62667_CR10","unstructured":"Public Health England. Tuberculosis in England 2017 report (presenting data to end of 2016). Available from, https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/686185\/TB_Annual_Report_2017_v1.1.pdf. (2017)."},{"issue":"39","key":"62667_CR11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta21390","volume":"21","author":"P Mangtani","year":"2017","unstructured":"Mangtani, P. et al. Observational study to estimate the changes in the effectiveness of bacillus Calmette-Guerin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK. Health Technol. Assess. 21(39), 1\u201354, https:\/\/doi.org\/10.3310\/hta21390 (2017).","journal-title":"Health Technol. Assess."},{"issue":"5","key":"62667_CR12","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1093\/oxfordjournals.aje.a114174","volume":"122","author":"P Bruzzi","year":"1985","unstructured":"Bruzzi, P., Green, S. B., Byar, D. P., Brinton, L. A. & Schairer, C. Estimating the population attributable risk for multiple risk factors using case-control data. Am. J. Epidemiol. 122(5), 904\u201314 (1985).","journal-title":"Am. J. Epidemiol."},{"issue":"4","key":"62667_CR13","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1017\/S0950268808001118","volume":"137","author":"CE French","year":"2009","unstructured":"French, C. E., Kruijshaar, M. E., Jones, J. A. & Abubakar, I. The influence of socio-economic deprivation on tuberculosis treatment delays in England, 2000-2005. Epidemiol. Infect. 137(4), 591\u20136, https:\/\/doi.org\/10.1017\/S0950268808001118 (2009).","journal-title":"Epidemiol. Infect."},{"issue":"11","key":"62667_CR14","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.5588\/ijtld.10.0252","volume":"15","author":"JL Alvarez","year":"2011","unstructured":"Alvarez, J. L. et al. Educational inequalities in tuberculosis mortality in sixteen European populations. Int. J. Tuberc. Lung Dis. 15(11), 1461\u20137, i, https:\/\/doi.org\/10.5588\/ijtld.10.0252 (2011).","journal-title":"Int. J. Tuberc. Lung Dis."},{"issue":"1","key":"62667_CR15","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1136\/jech.2004.023531","volume":"60","author":"B Galobardes","year":"2006","unstructured":"Galobardes, B., Shaw, M., Lawlor, D. A., Lynch, J. W. & Davey Smith, G. Indicators of socioeconomic position (part 1). J. Epidemiol. Community Health. 60(1), 7\u201312, https:\/\/doi.org\/10.1136\/jech.2004.023531 (2006).","journal-title":"J. Epidemiol. Community Health."},{"issue":"11","key":"62667_CR16","doi-asserted-by":"publisher","first-page":"1750","DOI":"10.2105\/AJPH.84.11.1750","volume":"84","author":"SE Buskin","year":"1994","unstructured":"Buskin, S. E., Gale, J. L., Weiss, N. S. & Nolan, C. M. Tuberculosis risk factors in adults in King County, Washington, 1988 through 1990. Am. J. Public. Health. 84(11), 1750\u20136 (1994).","journal-title":"Am. J. Public. Health."},{"issue":"1","key":"62667_CR17","first-page":"44","volume":"15","author":"K Ladefoged","year":"2011","unstructured":"Ladefoged, K. et al. Risk factors for tuberculosis in Greenland: case-control study. Int. J. Tuberc. Lung Dis. 15(1), 44\u20139 (2011).","journal-title":"Int. J. Tuberc. Lung Dis."},{"issue":"5001","key":"62667_CR18","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1136\/bmj.2.5001.1081","volume":"2","author":"CR Lowe","year":"1956","unstructured":"Lowe, C. R. An association between smoking and respiratory tuberculosis. Br. Med. J. 2(5001), 1081\u20136 (1956).","journal-title":"Br. Med. J."},{"issue":"6","key":"62667_CR19","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1136\/jech-2014-204292","volume":"69","author":"GS Smith","year":"2015","unstructured":"Smith, G. S. et al. Cigarette smoking and pulmonary tuberculosis in northern California. J. Epidemiol. Community Health. 69(6), 568\u201373, https:\/\/doi.org\/10.1136\/jech-2014-204292 (2015).","journal-title":"J. Epidemiol. Community Health."},{"issue":"1","key":"62667_CR20","doi-asserted-by":"publisher","first-page":"e20","DOI":"10.1371\/journal.pmed.0040020","volume":"4","author":"HH Lin","year":"2007","unstructured":"Lin, H. H., Ezzati, M. & Murray, M. Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta-analysis. PLoS Med. 4(1), e20, https:\/\/doi.org\/10.1371\/journal.pmed.0040020 (2007).","journal-title":"PLoS Med."},{"key":"62667_CR21","unstructured":"National Centre for Social Research, National Foundation for Educational Research. Smoking, Drinking and Drug Use Among Young People in England - 2014: Health and Social Care Information Centre; 2015. Available from, http:\/\/content.digital.nhs.uk\/catalogue\/PUB17879."},{"issue":"5","key":"62667_CR22","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1038\/nri2530","volume":"9","author":"MR Stampfli","year":"2009","unstructured":"Stampfli, M. R. & Anderson, G. P. How cigarette smoke skews immune responses to promote infection, lung disease and cancer. Nat. Rev. Immunol. 9(5), 377\u201384, https:\/\/doi.org\/10.1038\/nri2530 (2009).","journal-title":"Nat. Rev. Immunol."},{"key":"62667_CR23","unstructured":"U.S. Department of Health and Human Services. Other Specific Outcomes - Immune Function and Autoimmune Disease. The Health Consequences of Smoking: 50 Years of Progress: A Report of the Surgeon General. Atlanta (GA), USA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; p. 545\u201371 (2014)."},{"issue":"3","key":"62667_CR24","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1001\/archinte.1979.03630400053020","volume":"139","author":"LB Reichman","year":"1979","unstructured":"Reichman, L. B., Felton, C. P. & Edsall, J. R. Drug dependence, a possible new risk factor for tuberculosis disease. Arch. Intern. Med. 139(3), 337\u20139 (1979).","journal-title":"Arch. Intern. Med."},{"issue":"2","key":"62667_CR25","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1001\/archinternmed.2008.535","volume":"169","author":"JE Oeltmann","year":"2009","unstructured":"Oeltmann, J. E., Kammerer, J. S., Pevzner, E. S. & Moonan, P. K. Tuberculosis and substance abuse in the United States, 1997\u20132006. Arch. Intern. Med. 169(2), 189\u201397, https:\/\/doi.org\/10.1001\/archinternmed.2008.535 (2009).","journal-title":"Arch. Intern. Med."},{"issue":"9","key":"62667_CR26","doi-asserted-by":"publisher","first-page":"1466","DOI":"10.3201\/eid1409.070654","volume":"14","author":"A Story","year":"2008","unstructured":"Story, A., Bothamley, G. & Hayward, A. Crack cocaine and infectious tuberculosis. Emerg. Infect. Dis. 14(9), 1466\u20139, https:\/\/doi.org\/10.3201\/eid1409.070654 (2008).","journal-title":"Emerg. Infect. Dis."},{"key":"62667_CR27","unstructured":"Rieder, H. L. Epidemiologic basis of tuberculosis control. Paris: International Union Against Tuberculosis and Lung Disease; (1999)."},{"issue":"6","key":"62667_CR28","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1183\/09031936.01.00211701","volume":"18","author":"K Tocque","year":"2001","unstructured":"Tocque, K. et al. A case-control study of lifestyle risk factors associated with tuberculosis in Liverpool, North-West England. Eur. Respir. J. 18(6), 959\u201364 (2001).","journal-title":"Eur. Respir. J."},{"key":"62667_CR29","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-8-289","volume":"8","author":"K Lonnroth","year":"2008","unstructured":"Lonnroth, K., Williams, B. G., Stadlin, S., Jaramillo, E. & Dye, C. Alcohol use as a risk factor for tuberculosis - a systematic review. BMC Public. Health. 8, 289, https:\/\/doi.org\/10.1186\/1471-2458-8-289 (2008).","journal-title":"BMC Public. Health."},{"key":"62667_CR30","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1164\/arrd.1964.90.1.48","volume":"90","author":"JS Chapman","year":"1964","unstructured":"Chapman, J. S. & Dyerly, M. D. Social and Other Factors in Intrafamilial Transmission of Tuberculosis. Am. Rev. Respir. Dis. 90, 48\u201360, https:\/\/doi.org\/10.1164\/arrd.1964.90.1.48 (1964).","journal-title":"Am. Rev. Respir. Dis."},{"issue":"12","key":"62667_CR31","doi-asserted-by":"publisher","first-page":"e1000381","DOI":"10.1371\/journal.pmed.1000381","volume":"7","author":"I Baussano","year":"2010","unstructured":"Baussano, I. et al. Tuberculosis incidence in prisons: a systematic review. PLoS Med. 7(12), e1000381, https:\/\/doi.org\/10.1371\/journal.pmed.1000381 (2010).","journal-title":"PLoS Med."},{"issue":"12","key":"62667_CR32","doi-asserted-by":"publisher","first-page":"1551","DOI":"10.1046\/j.1360-0443.2002.00229.x","volume":"97","author":"A Boys","year":"2002","unstructured":"Boys, A. et al. Drug use and initiation in prison: results from a national prison survey in England and Wales. Addiction. 97(12), 1551\u201360 (2002).","journal-title":"Addiction."},{"key":"62667_CR33","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.ijid.2015.01.007","volume":"32","author":"GM Craig","year":"2015","unstructured":"Craig, G. M. & Zumla, A. The social context of tuberculosis treatment in urban risk groups in the United Kingdom: a qualitative interview study. Int. J. Infect. Dis. 32, 105\u201310, https:\/\/doi.org\/10.1016\/j.ijid.2015.01.007 (2015).","journal-title":"Int. J. Infect. Dis."},{"key":"62667_CR34","unstructured":"Public Health England\/NHS England. Collaborative Tuberculosis Strategy for England 2015 to 2020. London: Public Health England\/NHS England; 2015. Available from, https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/403231\/Collaborative_TB_Strategy_for_England_2015_2020_.pdf."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-62667-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-62667-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-62667-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T09:03:07Z","timestamp":1670317387000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-62667-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,27]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["62667"],"URL":"https:\/\/doi.org\/10.1038\/s41598-020-62667-8","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,27]]},"assertion":[{"value":"13 September 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 March 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"5639"}}