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R. Graham Barr, MD, MPH, Ana V. Diez-Roux, MD, PhD, Charles A. Knirsch, MD, MPH and Ariel Pablos-Méndez, MD, MPH

R. Graham Barr, Ana V. Diez-Roux, and Ariel Pablos-Méndez are with the Division of General Medicine, College of Physicians and Surgeons, Columbia University, New York, NY. Dr Barr is also with the General Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. Dr Diez-Roux and Dr Pablos-Méndez are also with the Division of Epidemiology, School of Public Health, Columbia University, New York, NY. Charles A. Knirsch is with the Division of Infectious Disease, College of Physicians and Surgeons, Columbia University, New York, NY. Dr Pablos-Méndez is also with the Rockefeller Foundation, New York, NY.

Correspondence: Requests for reprints should be sent to R. Graham Barr, MD, MPH, Division of General Medicine, PH-9 East, Columbia-Presbyterian Medical Center, 622 W 168th St, New York, NY 10032 (e-mail: rgb9{at}columbia.edu).

Objectives. The resurgence of tuberculosis (TB) in New York City has been attributed to AIDS and immigration; however, the role of poverty in the epidemic is unclear. We assessed the relation between neighborhood poverty and TB at the height of the epidemic and longitudinally from 1984 through 1992.

Methods. Census block groups were used as proxies for neighborhoods. For each neighborhood, we calculated TB and AIDS incidence in 1984 and 1992 with data from the Bureaus of Tuberculosis Control and AIDS Surveillance and obtained poverty rates from the census.

Results. For 1992, 3343 TB cases were mapped to 5482 neighborhoods, yielding a mean incidence of 46.5 per 100 000. Neighborhood poverty was associated with TB (relative risk = 1.33; 95% confidence interval = 1.30, 1.36 per 10% increase in poverty). This association persisted after adjustment for AIDS, proportion foreign-born, and race/ethnicity. Neighborhoods with declining income from 1980 to 1990 had larger increases in TB incidence than did neighborhoods with increasing income.

Conclusions. Leading up to and at the height of the TB epidemic in New York City, neighborhood poverty was strongly associated with TB incidence. Public health interventions should target impoverished areas.

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