Systematic Review and Meta-Analysis of Sex Differences in Social Contact Patterns and Implications for Tuberculosis Transmission and Control
Social contact patterns might contribute to excess burden of tuberculosis in men. We conducted a study of social contact surveys to evaluate contact patterns relevant to tuberculosis transmission. Available data describe 21 surveys in 17 countries and show profound differences in sex-based and age-based patterns of contact. Adults reported more adult contacts than children. Children preferentially mixed with women in all surveys (median sex assortativity 58%, interquartile range [IQR] 57%-59% for boys, 61% [IQR 60%-63%] for girls). Men and women reported sex-assortative mixing in 80% and 95% of surveys (median sex assortativity 56% [IQR 54%-58%] for men, 59% [IQR 57%-63%] for women). Sex-specific patterns of contact with adults were similar at home and outside the home for children; adults reported greater sex assortativity outside the home in most surveys. Sex assortativity in adult contacts likely contributes to sex disparities in adult tuberculosis burden by amplifying incidence among men. ; E.L.C. was supported by a Wellcome Trust Senior Research Fellowship in Clinical Science (WT091769). R.G.W. was supported the UK Medical Research Council and the UK Department for International Development under the Medical Research Council/Department for International Development Concordat agreement that is also part of the European and Developing Countries Clinical Trials Partnership 2 Programme supported by the European Union (MR/P002404/1); and the Bill and Melinda Gates Foundation (TB Modelling and Analysis Consortium: OPP1084276/OPP1135288, SA Modelling for Policy: OPP1110334, CORTIS: OPP1137034, Vaccines: OPP1160830) and UNITAID (4214-LSHTM-Sept15; PO 8477-0-600). ; Horton, KC (corresponding author), London Sch Hyg & Trop Med, Fac Epidemiol & Populat Hlth, Dept Infect Dis Epidemiol, Keppel St, London WC1E 7HT, England. katherine.horton@lshtm.ac.uk