Tuberculosis, for the year ended December 1934, ranked as the first cause of death in Puerto Rico. In many other countries the death rate from this disease, especially during the past twenty-five years, has had a downward trend, but in Puerto Rico it has shown a steady rise, demonstrated by the average annual rates of 170.5 in 1910-1914, 201.4 in 1920-1924 and 295.3 in 1930-1934 per hundred thousand of population. The last rate is approximately five times the death rate from tuberculosis in the United States registration area.
Among the important factors presumably responsible for the increase of the tuberculosis mortality in Puerto Rico, cognizance should be given to overcrowding in urban districts as a result of migration of families from rural areas to city slums; the lack of employment, which brings overcrowding in dwellings; the relatively low economic status of the island population, and the lack of hospital facilities
MORALES EG. PROGRAM FOR TUBERCULOSIS CONTROL IN PUERTO RICO. JAMA. 1935;105(23):1842–1844. doi:10.1001/jama.1935.02760490026007
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