Ethnic disparities in tuberculosis incidence and related factors among indigenous and other communities in ethnically diverse Suriname

F A Gopie; A Hassankhan; S Ottevanger; I Krishnadath; W de Lange; C W R Zijlmans; S Vreden

doi:10.1016/j.jctube.2021.100227

Ethnic disparities in tuberculosis incidence and related factors among indigenous and other communities in ethnically diverse Suriname

J Clin Tuberc Other Mycobact Dis. 2021 Mar 10:23:100227. doi: 10.1016/j.jctube.2021.100227. eCollection 2021 May.

Authors

F A Gopie^{1

2}, A Hassankhan³, S Ottevanger⁴, I Krishnadath², W de Lange^{5

6}, C W R Zijlmans^{2

7}, S Vreden⁸

Affiliations

¹ Pulmonologist, Academic Hospital Paramaribo, Paramaribo, Suriname.
² Anton de Kom University of Suriname, Faculty of Medical Sciences, Paramaribo, Suriname.
³ MoleMann Mental Health Suriname, Paramaribo, Suriname.
⁴ Amsterdam UMC, University of Amsterdam, Medical Microbiology, Amsterdam, The Netherlands.
⁵ University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands.
⁶ University of Groningen, University Medical Center Groningen, Tuberculosis Center Beatrixoord, Haren, The Netherlands.
⁷ Department of Paediatrics, Diakonessenhuis Hospital, Paramaribo, Suriname.
⁸ Department of Internal Medicine, Academic Hospital Paramaribo, Paramaribo, Suriname.

Abstract

Background: In Suriname, a country home to many ethnic groups, a high incidence of tuberculosis (TB) has been found among Indigenous Trio Amerindians. However, whether wider ethnic disparities in TB incidence and its associated risk factors (e.g., diabetes mellitus and HIV) exist in Suriname, is not known. We sought to investigate disparities in TB incidence and its risk factors on ethnicity in Suriname, as this could give way to targeted TB intervention programs.

Methods: Anonymized patient data from 2011 to 2015 was extracted from the National TB Registry and analyzed. Differences in the five-year incidence rates of TB for the six largest ethnic groups-Creole, Hindustani, Indigenous, Javanese, Maroon, and Mixed-were assessed using a chi-square goodness-of-fit test, and TB patient differences regarding ethnicity were evaluated for selected factors using a multinomial logistic regression with Creole patients as reference.

Results: 662 Patients were eligible for analyses with the following ethnic makeup: Creole (36.4%), Hindustani (15.6%), Indigenous (8.6%), Javanese (10.6%), Maroon (15.1%), and Mixed ethnicity (13.7%). Differences in five-year incidence rates for TB were significant, χ ²(5, N = 662) = 244.42, p < .001, and the highest TB rates were found for Indigenous (280 per 100,000) and Creole people (271 per 100,000). HIV coinfection was a TB risk factor for Creoles (38.2% of these patients were HIV positive). Several variables (i.e., those for drug use) had high levels of incomplete or missing data.

Conclusions: Our study has demonstrated that ethnic disparities in tuberculosis incidence exist in Suriname and that they are associated with specific, known risk factors such as HIV (especially for Creole people). For Indigenous people, risk factors may include diminished access to health care facilities and low socioeconomic status. However, direct data on these factors was unavailable. These findings call for targeted national intervention programs-with special attention given to the vulnerabilities of susceptible ethnic groups-and improved data collection.

Keywords: Ethnicity; HIV; Indigenous; Poverty.