Objective We investigated trends and determinants of pulmonary tuberculosis (PTB) in deceased South African miners.
Methods Statutory autopsies are performed on miners for occupational lung disease compensation, irrespective of cause of death. Data were extracted from the PATHAUT (Pathology Automation System) autopsy database. PTB trends were analysed and explanatory variables (year of autopsy, age at death, gold employment duration, silicosis and HIV) were evaluated using binary logistic regression modelling. Analyses were stratified by population group because of racial differences in socioeconomic status, employment patterns and access to facilities for autopsies. The analyses were segmented to represent the pre-HIV (1975–1989), rapid HIV spread (1990–2004) and antiretroviral therapy (2005–2014) periods.
Results The proportions of men with PTB at autopsy increased from 4.62% in 1975 to 27.18% in 2014 in black miners, and from 2.07% to 5.19% in white miners, with peaks in 2007 (43.12% and 9.51%, respectively). The magnitude and significance of adjusted ORs of determinants differed by population group and calendar period. PTB was largely associated with silicosis, increasing gold employment duration and year of autopsy (a surrogate for unmeasured confounders, such as unknown HIV status and tuberculosis transmission).
Conclusions Changes in PTB time trends and determinants reflect the complex social and political environment in which mining occurs. Silica dust reduction remains a key intervention for tuberculosis reduction, together with tuberculosis and HIV treatment and management. The autopsy data provide reliable information to monitor progress towards the achievement of industry and national targets to reduce tuberculosis.
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Contributors NN: substantially contributed to the conception and design of the work; acquisition, analysis and interpretation of data for the work; and drafting the work and revising it critically for important intellectual content. EM: substantially contributed to the analysis and interpretation of data for the work. SKP: substantially contributed to the design of the work; and analysis and interpretation of data for the work. BG-B: substantially contributed to the analysis and interpretation of data for the work. GR: substantially contributed to the conception and interpretation of data for the work. JM: substantially contributed to the conception of the work; and acquisition and interpretation of data for the work. EM, SKP, BG-B, GR, JM: revising the work critically for important intellectual content. NN, EM, SKP, BG-B, GR, JM: final approval of the version to be published. NN, EM, SKP, BG-B, GR, JM: agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The project was supported by Award Number D43ES018744 from the US National Institute of Environmental Health Sciences.
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Environmental Health Sciences or the National Institutes of Health.
Competing interests None declared.
Patient consent Next of kin consent obtained.
Ethics approval This study was approved by the University of the Witwatersrand Human Research Ethics Committee (clearance certificate number, M120236) and the University of Michigan Health Sciences and Behavioural Sciences Institutional Review Board (HUM00069012).
Provenance and peer review Not commissioned; externally peer reviewed.
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