Identification of High and Low-Risk Areas of Tuberculosis in Lorestan Province, West of Iran


1 Epidemiology & Biostatistics Department, Health Faculty, Mazandaran University of Medical Sciences, Sari, Iran,

2 Epidemiology & Biostatistics Department, Health Faculty, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Nowadays, tuberculosis (TB)–an infectious disease caused by Mycobacterium tuberculosis–presents with different location patterns. Spatial analysis is one of the most important tools to detect and monitor public health disease patterns. This study aimed to identify the low and high-risk areas in Lorestan Province (west of Iran) to help the health programmer for the best intervention. Materials and Methods: Lorestan has 9 counties, 22 cities, 25 zones, 81 villages, and 2842 residential villages. Our study cases were 1481 patients registered in the TB center of Lorestan Province. We investigated the spatial distribution of TB in Lorestan between 2002 and 2008 using a multilevel model. STATA Ver. 10 software was used for the data analysis. Results: The multilevel model was a better fit to the data for the spatial correlation structure. It adjusted relative risks by borrowing information of the neighboring areas in each village. Maximum risk of disease was seen in the central zone of Koram-Abad, and all villages of Delphan were identified as lowrisk areas. Conclusion: Various factors such as improvement of socio-economic conditions, implementation of programs, culture, genetic background, healthrelated behavior, and lifestyle can influence TB control substantially. A deprived region located in the southern part of Khoram-Abad was identified as the highest risk area in our study. The poor socio-economic structure can be an important factor for the increased risk of TB in this region.