Tuberculosis (TB) has long been identified as a disease predominantly affecting those living in poverty. However, most TB research fails to assess poverty meaningfully, leaving crucial gaps in our understanding and response strategies.
A new review published in the journal BMC Global and Public Health examines current methods for assessing socioeconomic status (SES) within TB studies and highlights significant shortcomings. Led by researchers from Boston University’s Chobanian & Avedisian School of Medicine, Brown University, and Oxford University, this comprehensive analysis explores various ways poverty has been measured in these studies.
The review includes an examination of income-based measures, wealth indices, and multidimensional poverty indices (MPIs). The authors found that many commonly used tools fail to capture key aspects of deprivation relevant to TB risk and treatment. These critical areas include food insecurity, overcrowded housing conditions, and limited access to healthcare services.
“Poverty isn’t just a backdrop—it’s central to understanding who develops TB and who faces challenges in its treatment,” explains Pranay Sinha, MD, an assistant professor of medicine at Boston University and the corresponding author. “Yet many TB studies rely on outdated or oversimplified measures of socioeconomic status, limiting our ability to learn effectively and respond appropriately.”
As part of their review, researchers also evaluated how frequently observational TB studies accounted for poverty. They found that out of the 100 most recently published observational TB studies, nearly 70% did not include any measure of SES. The authors argue that this lack of measurement can lead to misinterpretations of TB risk factors and policies that fail to reach the most vulnerable populations.
“If we don’t measure deprivation well, we can’t address it effectively,” says Chelsie Cintron, MPH, a co-first author, third-year doctoral student at Brown University, and senior research study coordinator at Boston Medical Center. “This missed opportunity is significant because poverty impacts every stage of the TB journey—from exposure to treatment outcomes.”
The researchers propose adopting more refined tools like the global multidimensional poverty index (MPI), which has been adapted for various contexts by Jakob Dirksen MSc, MPP—a research and policy officer at Oxford Poverty & Human Development Initiative. They argue that such tools could lead to more targeted interventions and stronger policy recommendations.
This research was supported by multiple institutions, including the National Institutes of Health, the Warren Alpert Foundation, the Burroughs Wellcome Fund/American Society for Tropical Medicine & Hygiene, and various government agencies in India.
