Type and physical intensity of occupations at pulmonary TB diagnosis

Pulmonary TB (PTB) predominantly affects individuals of working age. We sought to characterise the occupations of people newly diagnosed with PTB in Karachi, Pakistan, by type and physical intensity.

We did a secondary analysis of data from a study evaluating the diagnostic accuracy of artificial intelligence-based chest X-ray (CXR) analysis software, where individuals had been evaluated for active PTB using sputum cultures and had provided information on occupation. We used an accelerometer-validated US National Health and Nutrition Examination Survey-based job categorisation to assign physical activity levels to participant-reported occupations as High, Intermediate, or Low.

Among 272 participants with microbiologically confirmed PTB (women: 130/272, 48%; median age: 29 years, IQR 22-45), 78% (211/272) had smear-positive disease, and 96% (260/272) had data on occupation. Unemployment was common (women: 70/122, 57%; men: 23/138, 17%). Most women reporting an occupation were homemakers (21/52, 40%), and 54% (28/52) had an intermediate- or a high physical activity occupation. Among men reporting an occupation, 35% (40/115) were labourers, and 79% (91/115) had an intermediate- or high-physical activity occupation.

The majority of individuals with PTB were in their working age, had extensive disease, and had intermediate or high physical activity occupations, suggesting economic vulnerability due to physical impairment.