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. 2016 Feb 16;11(2):e0149195.
doi: 10.1371/journal.pone.0149195. eCollection 2016.

Tuberculosis Mortality and Living Conditions in Bern, Switzerland, 1856-1950

Kathrin Zürcher  1 , Marie Ballif  1   2   3 , Marcel Zwahlen  1 , Hans L Rieder  4 , Matthias Egger  1 , Lukas Fenner  1   2   3
Affiliations

Tuberculosis Mortality and Living Conditions in Bern, Switzerland, 1856-1950

Kathrin Zürcher et al. PLoS One. .

Abstract

Background: Tuberculosis (TB) is a poverty-related disease that is associated with poor living conditions. We studied TB mortality and living conditions in Bern between 1856 and 1950.

Methods: We analysed cause-specific mortality based on mortality registers certified by autopsies, and public health reports 1856 to 1950 from the city council of Bern.

Results: TB mortality was higher in the Black Quarter (550 per 100,000) and in the city centre (327 per 100,000), compared to the outskirts (209 per 100,000 in 1911-1915). TB mortality correlated positively with the number of persons per room (r = 0.69, p = 0.026), the percentage of rooms without sunlight (r = 0.72, p = 0.020), and negatively with the number of windows per apartment (r = -0.79, p = 0.007). TB mortality decreased 10-fold from 330 per 100,000 in 1856 to 33 per 100,000 in 1950, as housing conditions improved, indoor crowding decreased, and open-air schools, sanatoria, systematic tuberculin skin testing of school children and chest radiography screening were introduced.

Conclusions: Improved living conditions and public health measures may have contributed to the massive decline of the TB epidemic in the city of Bern even before effective antibiotic treatment became finally available in the 1950s.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Changes in the mortality due to injuries (including homicide), communicable (infectious diseases and infant death) and non-communicable diseases (including cancer) in the capital city of Bern, Switzerland, between1856 and 1950.
Bars represent average 5-year mortality; the black curve represents tuberculosis (TB) mortality. Data were not available for the years 1868–1869, 1871 and 1926 to1928.
Fig 2
Fig 2. TB mortality by quarter in the city of Bern, Switzerland, between 1911 and 1915.
Bern consisted of five quarters in the City centre including the “Black Quarter” (named after colours since the Napoleonic occupation), and five quarters in the city outskirts.
Fig 3
Fig 3. Correlation between TB mortality according the total number of windows per apartment (Fig A) and the percentage of rooms without direct day light (Fig B) in the ten quarters of Bern, 1911–1915.
Fig 4
Fig 4. Trends in TB mortality in the city of Bern, Switzerland, between1856 to 1950, in relation to important events for TB control.
Boxes in grey show worldwide events.
See this image and copyright information in PMC

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