Background Europe’s Great Recession has increased poverty and, in many, countries reduced social welfare expenditure. With rising poverty, the risk of tuberculosis also increases and some countries have reported rising tuberculosis incidence rates. We investigate whether the recession and subsequent social protection austerity can explain this variation in tuberculosis outcomes.

Methods Using estimated incidence, prevalence and mortality rates from the World Health Organisation and social protection expenditure data from EuroStat, we estimate multivariate statistical models to evaluate changes in tuberculosis outcomes rates in 21 EU countries from 1995–2012. Models are adjusted for country fixed effects.

Results Since 1995, most EU countries have achieved high levels of tuberculosis case detection rates (˜85%). However, following the onset of the recession there has been a decline in the levels of case detection in some countries. A USD $100 per capita reduction in public health spending reduces the case detection rate by 3.09% (95% CI: 0.84% to 5.48%). Both estimated smear positive and estimated smear negative/extra pulmonary tuberculosis have declined steadily since 1995. In 2011–2012, this trend reversed. The estimated smear negative and extra pulmonary incidence rate increased by 2.00 cases per 100,000 (95% CI: 0.76 to 3.23) and the estimated smear positive incidence rate increased by 0.49 cases per 100,000 (95% CI: 0.04 to 0.94). This rise is concentrated in those countries that implemented social protection austerity after 2008. Between 1995–2012, a USD $100 increase in social protection spending reduced the estimated incidence rate by 1.44% (95% CI: 0.13% to 2.75%) and reduced the tuberculosis mortality rate by 2.83% (95% CI: 0.64% to 5.01%). Disaggregating the different types of social protection spending we find that a USD $100 increase in social protection spending on the elderly reduces the estimated incidence rate by 3.97% (95% CI: 2.15% to 5.79%) and the tuberculosis mortality rate by 7.81% (95% CI: 4.28% to 11.4%).

Conclusion Despite potential measurement error in the WHO estimation procedures, these results suggest that healthcare and social protection austerity may increase the tuberculosis incidence rate. In particular, increased social protection expenditure protects some high risk groups, such as the elderly.