Addressing social determinants of tuberculosis (TB) is essential to achieve elimination, including in low-incidence settings. We measured the association between socio-economic status and intermediate social determinants of health (SDHs, including drug misuse, tobacco smoking and alcohol), and TB, taking into account their clustering in individuals. We conducted a case-control study in 23–38 years old UK-born White adults with first tuberculosis episode, and randomly selected age and sex frequency-matched community controls. Data was collected on education, household overcrowding, tobacco smoking, alcohol and drugs use, and history of homelessness and prison. Analyses were done using logistic regression models, informed by a formal theoretical causal framework (Directed Acyclic Graph). 681 TB cases and 1183 controls were recruited. Tuberculosis odds were four times higher in subjects with education below GCSE O-levels, compared to higher education (OR = 3.94; 95%CI: 2.74, 5.67), after adjusting for other TB risk factors (age, sex, BCG-vaccination and stays ≥3 months in Africa/Asia). When simultaneously accounting for respective SDHs, higher tuberculosis risk was independently associated with tobacco smoking, drugs use (especially injectable drugs OR = 5.67; 95%CI: 2.68, 11.98), homelessness and area-level deprivation. Population Attributable Fraction estimates suggested that tobacco and class-A drug use were, respectively, responsible for 18% and 15% of TB cases in this group. Our findings suggest that socio-economic deprivation remains a driver of tuberculosis in England, including through drugs misuse, tobacco smoking, and homelessness. These findings further support the integration of health and social services in high-risk young adults to improve TB control efforts.

解决结核病（TB）的社会决定因素对于实现消灭疾病（包括在低发病率的环境中）至关重要。我们测量了社会经济地位和健康的中间社会决定因素（SDH，包括滥用药物，吸烟和酗酒）与结核病之间的关联，并考虑了它们在个人中的聚集。我们对23-38岁在英国出生的首次结核病发作的白人成年人进行了病例对照研究，并随机选择了与年龄和性别频率相匹配的社区对照。收集了有关教育，家庭拥挤，吸烟，酗酒和吸毒以及无家可归和入狱史的数据。在正式的理论因果框架（有向无环图）的指导下，使用逻辑回归模型进行了分析。招募了681例TB病例和1183例对照。在校正了其他结核病危险因素（年龄，性别，BCG疫苗接种和其他因素）后，接受GCSE O水平以下教育的受试者与接受高等教育的受试者相比，结核病几率高出四倍（OR = 3.94； 95％CI：2.74、5.67）。在非洲/亚洲停留≥3个月）。同时考虑到各自的SDH时，较高的结核病风险与吸烟，吸毒（尤其是可注射药物OR = 5.67； 95％CI：2.68、11.98），无家可归和地区一级的剥夺有关。人群归因分数估计表明，烟草和A类药物的使用分别占该组结核病例的18％和15％。我们的发现表明，在英国，社会经济剥夺仍然是结核病的驱动因素，包括滥用毒品，吸烟和无家可归。