Journal of Public Health

, Volume 27, Issue 5, pp 541–552 | Cite as

Political, economic, and health system determinants of tuberculosis incidence

  • Ashley E. RutherfordEmail author
  • Lynn Unruh
Original Article



Although global tuberculosis (TB) rates have decreased, multidrug-resistant strains have become a concern. Traditionally, causes of infectious diseases are determined through health and health system factors, yet socioeconomic and political variables may influence a nation’s vulnerability and response to infectious disease control. This study explores relationships among political stability, economic stability, tuberculosis detection policies, health system constructs, and the incidence of tuberculosis.

Subjects and methods

A retrospective, cross-sectional, observational design was employed using open-source, secondary, 2014 country-level data from the World Bank and World Health Organization. A structural equation model examined the direct and indirect effects of economic, political, and other constructs on tuberculosis incidence rates.


Political and economic stability, health system indicators, and detection policies all covaried. Political stability, health system indicators, and detection policies directly affected tuberculosis incidence rates, but economic stability did not. Political stability and health system indicators were negatively associated with tuberculosis incidence, while detection policies were positively associated.


Countries with greater political stability and better health systems experienced lower TB incidence, but countries with more detection policies in place had higher TB incidence rates. Economic stability did not directly affect TB incidence, but covaried positively with political stability, indicating strong links to political stability.


Tuberculosis incidence Political stability Health expenditures 


Compliance with ethical standards

This retrospective study did not involve human participants or animals and was exempted by the University of Central Florida IRB. No external funds were used in the research, and the authors have not and will not receive honoraria or other financial gain from the research. In sum:

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Conflict of interest

The authors declare no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.United States Air ForceJB CharlestonUSA
  2. 2.Department of Health Management & InformaticsUniversity of Central FloridaOrlandoUSA

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