Trends and determinants of tuberculosis incidence in Turkey: A secondary data analysis
Clinical Snapshot
PICO Framework
| P — Population | Turkish population from 1982-2021 |
| I — Intervention | Various socioeconomic and health system factors (Human Development Index, economic indicators, population metrics, health services) |
| C — Comparator | Time trends and varying levels of exposure to determinants |
| O — Outcomes | Tuberculosis incidence rates |
Bottom Line
This ecological study demonstrates a substantial 86.6% decline in tuberculosis incidence in Turkey over four decades, with Human Development Index being the strongest independent predictor. While the magnitude of reduction is impressive, the ecological design limits causal inference and individual-level application. The findings support the importance of broader socioeconomic development in TB control, consistent with WHO End TB Strategy emphasis on addressing social determinants. However, the study's limited variable selection and lack of detailed methodology raise questions about residual confounding. For Australian clinicians, these findings reinforce the importance of addressing social determinants in high-risk populations, though direct applicability is limited given Australia's different TB epidemiology and higher baseline development indicators.
Key Findings
P Value: P < .001 for Human Development Index association
Effect Size: 86.6% overall reduction in TB incidence from 1982-2021
Primary Outcome: Tuberculosis incidence rates in Turkey
Nnt Or Sensitivity: β = -1.041 for HDI association (regression coefficient)
Confidence Interval: Not reported in abstract
Clinical Application
HDI improvements require long-term societal development rather than direct clinical intervention Limited direct applicability - Australia has different TB epidemiology (low incidence, primarily in specific populations), established healthcare system, and higher baseline HDI Population-level tuberculosis control programs in middle-income countries
Abstract
Tuberculosis remains a major public health concern, with incidence rates influenced by social determinants of health. Although tuberculosis incidence in Turkey has declined markedly in recent decades, the factors associated with this decline have not been comprehensively evaluated at the country-level. This study aimed to examine trends in tuberculosis incidence in Turkey from 1982 to 2021 and to identify determinants of tuberculosis incidence rates between 2000 and 2021, considering variables categorized under composite development, economic indicators, population, and health services. A longitudinal ecological study was conducted using secondary data to examine trends and determinants of tuberculosis incidence in Turkey. Univariate and multivariable linear regression were employed to evaluate the associations between tuberculosis incidence rates and 10 selected variables. Tuberculosis incidence in Turkey declined substantially over the 40-year period analyzed, with an overall decrease of 86.6% and sharper reductions observed in certain intervals. In multivariable linear regression, only the Human Development Index remained independently associated with tuberculosis incidence (β = -1.041, P < .001), indicating that higher Human Development Index values were associated with lower tuberculosis incidence rates in Turkey. These findings indicate that tuberculosis incidence in Turkey has declined alongside changes in human development, as reflected by the composite Human Development Index.
References
- 1.Demirtaş, Y., & Şahinöz, T. (2026). Trends and determinants of tuberculosis incidence in Turkey: A secondary data analysis. Medicine, 105(15), e48278. https://doi.org/10.1097/MD.0000000000048278
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