The geography of tuberculosis mortality in Belgium between 1889 and 1991: a descriptive analysis

Abstract

Tuberculosis (TB) was the leading cause of death in Western countries during the 18th and 19th centuries, rising with industrialization and urbanization, then declining in the 20th century due to improved living conditions, public health measures, and medical advances. While the epidemiology of TB in Belgium has been well described, the spatial and temporal features are less well known. In this article, we examine TB mortality data from “Le Mouvement de la Population et de l’État Civil” at the municipality level between 1889 and 1991. We map TB mortality trends using an intermediate degree of aggregation of 19th and 20th century municipalities across six periods. The results reveal important spatiotemporal disparities, with mortality hotspots in municipalities with healthcare institutions. Diverging socioeconomic trajectories in Flanders (Dutch-speaking North) and Wallonia (French-speaking South) contributed to shifting mortality rates, from the highest in Flanders in the early 20th century to the highest in Wallonia after 1950. A significant sex difference emerged in the second half of the 20th century, with men experiencing higher mortality. Despite an overall decline in TB from the mid-19th century, the decline was heterogeneous across regions and periods, suggesting a link between TB and socioeconomic conditions. Further research is needed to better understand the factors driving TB trends in Belgium from 1889 to 1991.

Keywords

• geography
• inequality
• Belgium
• tuberculosis
• infectious diseases