Public Health (2008) 122, 613–619 Original Research Tuberculosis in Turkey: high altitude and other socio-economic risk factors A.C. Tanrikulu a, , H. Acemoglu b , Y. Palanci c , C. Eren Dagli d a Department of Chest Diseases, Faculty of Medicine, Kafkas University, Turkey b Department of Medical Education, Faculty of Medicine, Ataturk University, Turkey c State Office of Public Health, City Health Principal of Bitlis, Turkey d Department of Chest Diseases, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Turkey Received 24 January 2007; received in revised form 29 June 2007; accepted 3 September 2007 Available online 21 February 2008 KEYWORDS Tuberculosis; Altitude; Socio-economic factors Summary Background: In Turkey, there are insufficient data regarding the relation between altitude and the incidence of tuberculosis (TB). Objectives: This study aimed to investigate the effect of high altitude and socio- economic conditions on the incidence of TB in Turkey. Methods: The mean incidence of TB in 56 Turkish cities was measured as n/100,000 population between 1999 and 2005. The mean altitude of each city was recorded in metres. Results: The incidence of TB was lower in cities located at high altitude (P ¼ 0.000) and higher in cities with a high population density (P ¼ 0.000). Multivariate analysis showed that the incidence of TB in low altitude cities was 3.28-fold higher than in high altitude cities (P ¼ 0.000). In cities with a population density 480 people/km 2 , the incidence of TB was 4.18-fold higher than in cities with a lower population density (P ¼ 0.000) Other factors found to affect the incidence of TB were having a social insurance card and a low annual income. Conclusions: There was a strong negative correlation between altitude and the incidence of TB, and population density was significantly associated with the incidence of TB. Possession of a social insurance card and fertility rate were also risk factors for TB. The authors believe that altitude has a stronger influence on the incidence of TB than the other factors. The effect of altitude on TB may reveal new data, but further studies need to be undertaken to assess the effects of potential factors on the incidence of TB. & 2007 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. ARTICLE IN PRESS www.elsevierhealth.com/journals/pubh 0033-3506/$ - see front matter & 2007 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2007.09.005 Corresponding author. Tel.: +90474 2127915/3294; fax: +90474 2120996. E-mail address: cetintanrikulu@hotmail.com (A.C. Tanrikulu).