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- Anne Christine Nordholm1,2,*
, Anja Joergensen2,*, Louise Hedevang Holm1, Aase Bengaard Andersen3, Anders Koch1,3, Peter Henrik Andersen1,**, Troels Lillebaek2,4,** View AffiliationsHide Affiliations
Affiliations:
1Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
2International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
3Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
4Department of Public Health, University of Copenhagen, Copenhagen, Denmark
*These authors contributed equally to the work and share first authorship.
**These authors contributed equally to the work and share last authorship.
Correspondence:
Anne Christine Nordholm
anchssi.dk
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Citation style for this article:Nordholm Anne Christine, Joergensen Anja, Holm Louise Hedevang, Andersen Aase Bengaard, Koch Anders, Andersen Peter Henrik, Lillebaek Troels.The impact of living conditions and health interventions on tuberculosis, Denmark, 1876 to 2022.Euro Surveill. 2024;29(24):pii=2300652.https://doi.org/10.2807/1560-7917.ES.2024.29.24.2300652Received: 20 Nov 2023;Accepted: 18 Apr 2024
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SDG 3: Tuberculosis
Abstract
Background
Denmark possesses an exceptional historical data collection on tuberculosis (TB) from 1876 to the present, providing a unique opportunity to assess TB epidemiology over 147 years in Denmark.
Aim
Our aim was to describe the TB disease burden in Denmark in relation to historical events, living conditions and health interventions during the past 147 years.
Methods
We performed a nationwide register-based ecological study including all persons with TB in Denmark from 1876 through 2022, correlating the TB incidence to social, economic and health indicators.
Results
In Denmark, the overall TB incidence and mortality declined markedly over the past 147 years, only marginally influenced by specific TB interventions such as sanatoria, Bacillus Calmette-Guèrin (BCG) vaccination, mass screenings and antibiotics. Parallel to this decline, the country experienced improved living conditions, as illustrated by decreased infant mortality and increased life expectancy and wealth. In 1978, Denmark became a low-incidence country for TB with risk groups predominantly affected, and with a continuous change in demographics towards fewer Danish-born cases and relatively more migrant cases.
Conclusions
The decline over time in TB incidence and mortality in Denmark preceded specific TB interventions and can, first of all, be attributed to improved living conditions. TB has now become a rare disease in Denmark, predominantly occurring in particular risk groups. Future elimination of TB will require a combination of specific health interventions in these risk groups combined with a continued focus on improving socioeconomic status and living conditions.
© 
This work is licensed under a Creative Commons Attribution 4.0 International License.
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The impact of living conditions and health interventions on tuberculosis, Denmark, 1876 to 2022
<p class="citation"><span>Citation style for this article:</span><span class="meta-value authors"><a href="/search?value1=Anne+Christine+Nordholm&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nordholm Anne Christine</a>, <a href="/search?value1=Anja+Joergensen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Joergensen Anja</a>, <a href="/search?value1=Louise+Hedevang+Holm&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Holm Louise Hedevang</a>, <a href="/search?value1=Aase+Bengaard+Andersen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Andersen Aase Bengaard</a>, <a href="/search?value1=Anders+Koch&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Koch Anders</a>, <a href="/search?value1=Peter+Henrik+Andersen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Andersen Peter Henrik</a>, <a href="/search?value1=Troels+Lillebaek&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lillebaek Troels</a></span>.The impact of living conditions and health interventions on tuberculosis, Denmark, 1876 to 2022.<a href="/content/ecdc">Euro Surveill.</a> 2024;29(24):pii=2300652.<a href="https://doi.org/10.2807/1560-7917.ES.2024.29.24.2300652" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.24.2300652</a><span class="ES_Article_citation"><span class="generated">Received</span>: 20 Nov 2023; <span class="generated">Accepted</span>: 18 Apr 2024 </span></p>
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