Rethinking the socioeconomics and geography of tuberculosis among foreign-born residents of New Jersey, 1994-1999

Understanding the intersection of race and place: the case of tuberculosis in Michigan

BACKGROUND

Race and place intersect to produce location-based variation in disease distributions. We analyzed the geographic distribution of tuberculosis (TB) incidence in Michigan, USA to better understand the complex interplay between race and place, comparing patterns in Detroit, Wayne County and the state of Michigan as a whole.

METHODS

Using cross-sectional TB surveillance data from the Michigan Department of Health and Human Services, multivariable statistical models were developed to analyze the residence patterns of TB incidence from 2007 through 2012. Two-way interactions among the residence location and race of cases were assessed.

RESULTS

Overall, Detroit residents experienced 58% greater TB incidence than residents of Wayne County or the state of Michigan. Racial inequalities were less pronounced in Detroit compared to both Wayne County and the state of Michigan. Blacks in Detroit had 2.01 times greater TB incidence than Whites, while this inequality was 3.62 times more in Wayne County and 8.72 greater in the state of Michigan.

CONCLUSION

Our results highlight how race and place interact to influence patterns of TB disease, and the ways in which this interaction is context dependent. TB elimination in the U.S. will require strategies that address the local social environment, as much as the physical environment.

Latent Tuberculosis Infection Beliefs and Testing and Treatment Health Behaviors Amongst Non-US-Born South Asians in New Jersey: A Cross-Sectional Community Survey

Latent tuberculosis infection (LTBI) remains a problem in the United States as reactivation leads to active TB disease particularly in persons with risk factors. The objective of this study is to assess the knowledge, attitudes and health behaviors related to testing and treatment of LTBI among non-US-born South Asians (SA) in New Jersey (NJ). A cross-sectional, community-based survey was the primary tool for gathering data. Eligibility criteria included being at least 18 years of age, self-identifying as SA, verbal consent for participation, and birth in a high TB endemic country. A hardcopy survey was distributed at local South Asian health fairs. The survey included questions about demographics, knowledge, beliefs on TB, and health behaviors (testing and treatment). Descriptive statistics were performed for all survey responses. Logistic regression models were constructed to assess the association of characteristics/beliefs and study outcomes. The survey sample size included 387 respondents. A total of 197 (54%) of respondents reported ever been tested for TB. Those who were tested for TB were generally younger, had higher educational levels, higher household incomes, and were more likely to have health insurance than those not ever tested for TB. Significantly more respondents who self-reported ever been tested for TB believed that TB was very or extremely serious (71.1% vs. 56.2%, p = 0.004). Also, significantly more respondents who self-reported ever been tested for TB believed that it was important to get tested (91.2% vs. 63.3%, p < 0.001). The survey analysis concluded that high-risk SA residents in NJ demonstrated a low rate of testing for TB.

Race and nativity are major determinants of tuberculosis in the U.S.: evidence of health disparities in tuberculosis incidence in Michigan, 2004-2012

Background

The incidence of TB in Michigan was 1.5 per 100,000 people in 2012, roughly half the U.S. incidence. Despite successes in TB control, disparities in TB still exist in Michigan, particularly by race, age, and nativity. A major challenge in understanding disparities in TB burden is distinguishing between TB cases resulting from recent transmission and those resulting from reactivation of latent TB infection, information critical to tailoring control strategies. We examined nine-year trends in tuberculosis (TB) incidence patterns for the entire population of Michigan, and within demographic subgroups.

Methods

Using a cross-sectional study of TB surveillance data, we analyzed 1254 TB cases reported in Michigan during 2004–2012. Cases included were those for whom both spoligotyping and 12-locus-MIRU-VNTR results were available. Using a combination of the genotyping information and time of diagnosis, we then classified cases as resulting from either recent transmission or reactivation of latent TB infection. We used multivariable negative binomial regression models to study trends in the TB incidence rate for the entire population and by race, nativity, gender, and age.

Results

Overall, the incidence rate of TB declined by an average of 8% per year—11% among recently transmitted cases, and 9% among reactivation cases. For recently transmitted disease, Blacks had an average incidence rate 25 times greater than Whites, after controlling for nativity, gender, and age. For disease resulting from latent TB infection Asians had an average incidence rate 24 times greater than Whites, after controlling for nativity, gender, and age.

Conclusions

Disparities in incidence persist despite ongoing TB control efforts. Greater disparities were observed by race and nativity demonstrating some of the ways that TB incidence is socially patterned. Reducing these disparities will require a multi-faceted approach encompassing the social and environmental contexts of high-risk populations.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4461-y) contains supplementary material, which is available to authorized users.

A national study of socioeconomic status and tuberculosis rates by country of birth, United States, 1996-2005

BACKGROUND

Tuberculosis (TB) in developed countries has historically been associated with poverty and low socioeconomic status (SES). In the past quarter century, TB in the United States has changed from primarily a disease of native-born to primarily a disease of foreign-born persons, who accounted for more than 60% of newly-diagnosed TB cases in 2010. The purpose of this study was to assess the association of SES with rates of TB in U.S.-born and foreign-born persons in the United States, overall and for the five most common foreign countries of origin.

METHODS

National TB surveillance data for 1996-2005 was linked with ZIP Code-level measures of SES (crowding, unemployment, education, and income) from U.S. Census 2000. ZIP Codes were grouped into quartiles from low SES to high SES and TB rates were calculated for foreign-born and U.S.-born populations in each quartile.

RESULTS

TB rates were highest in the quartiles with low SES for both U.S.-born and foreign-born populations. However, while TB rates increased five-fold or more from the two highest to the two lowest SES quartiles among the U.S.-born, they increased only by a factor of 1.3 among the foreign-born.

CONCLUSIONS

Low SES is only weakly associated with TB among foreign-born persons in the United States. The traditional associations of TB with poverty are not sufficient to explain the epidemiology of TB among foreign-born persons in this country and perhaps in other developed countries. TB outreach and research efforts that focus only on low SES will miss an important segment of the foreign-born population.

Tuberculosis among foreign-born persons, Singapore, 2000-2009

We determined the proportion of foreign-born persons with tuberculosis (TB) in Singapore. This proportion increased from 25.5% in 2004 to 37.6% in 2009. Unskilled workers from countries with high incidences of TB accounted for the highest number of and greatest increase in foreign-born TB case-patients.

Epidemiology of urban tuberculosis in the United States, 2000-2007

OBJECTIVES

We investigated tuberculosis (TB) incidence rates and characteristics of patients with TB in large US cities.

METHODS

Using the Centers for Disease Control and Prevention's National Tuberculosis Surveillance System data, we categorized 48 cities annually from 2000 to 2007 as reporting decreasing or nondecreasing rates with Joinpoint analysis. We compared demographic, clinical, and treatment characteristics of patients with TB using bivariate and multivariate analyses.

RESULTS

We found that 42 448 patients with TB in 48 cities accounted for 36% of all US patients with TB; these cities comprised 15% of the US population. The average TB incidence rate in the 48 cities (12.1 per 100,000) was higher than that in the US excluding the cities (3.8 per 100,000) but decreased at a faster rate. Nineteen cities had decreasing rates; 29 cities had nondecreasing rates. Patient characteristics did not conclusively distinguish decreasing and nondecreasing rate cities.

CONCLUSIONS

A significant TB burden occurs in large US cities. More than half (60%) of the selected cities did not show decreasing TB incidence rates. Studies of city-level variations in migration, socioeconomic status, and resources are needed to improve urban TB control.

[Spatial analysis of tuberculosis/HIV coinfection: its relation with socioeconomic levels in a city in south-eastern Brazil]

INTRODUCTION

Spatial analysis of the distribution of tuberculosis/HIV coinfection was performed and associated with socioeconomic indicators in São José do Rio Preto, from 1998 to 2006.

METHODS

New TB/HIV coinfection cases were georeferenced and incidence coefficients were calculated for spatial units. Moran's index was used to evaluate spatial associations of incidences. Multiple regressions selected variables that could best explain the spatial association of incidences. The local indicator of spatial association was used to identify significant spatial groupings.

RESULTS

Moran's index was 0.0635 (p=0.0000) indicating that the incidence association occurred. The variable that best explained the spatial association of incidence was the percentage of heads of families with up to three years of education. The LISA cluster map for TB/HIV coinfection incidence coefficients showed groups with high incidence rates in the North and low incidence in the South and West regions of the municipality.

CONCLUSIONS

The study elucidated the spatial geographic distribution of TB/HIV coinfection and determined its association with socioeconomic variables, thus providing data for oriented planning, prioritizing socially disadvantaged regions that present a higher incidence of the disease.

Increasing rate of childhood tuberculosis in a region of east Croatia

BACKGROUND

The incidence of childhood tuberculosis as well as the number of children being in contact with persons having tuberculosis has increased in the region of Slavonski Brod during the past decade (1993-2003). The region is located in east Croatia along the border with Bosnia and close to the besieged and destroyed town of Vukovar. The region was heavily involved in recent military activities and migrations in Croatia and Bosnia (1991-1995). Before the war, the population was reasonably well situated, educated and provided with health services.

METHODS

Routine clinical and epidemiological methods for the diagnosis of tuberculosis were used.

RESULTS

A total of 225 cases of tuberculosis were discovered among 271 suspected cases in a total number of 19 623 children below 18 years of age admitted during the last decade to the county hospital (1.38%). The number increased from three patients with tuberculosis in 1993 to 59 in 2003. Discharge diagnoses were: latent infection 40.1%, specific hilar lymphadenopathy 22.1%, primary lung tuberculosis 18.0%, postprimary tuberculosis 3.0%, and contact with infected person but otherwise normal findings 16.9%. The infection was usualy (53.1%) acquired within the family, more often so in younger patients. Bacteriological cultures were positive in 19 of 117 patients with tuberculosis (16.4%). Antituberculosis drug treatment was carried out to completion in all children. Resistance was not encountered.

CONCLUSION

The authors attribute high incidence of childhood tuberculosis in the region of Slavonski Brod, the second highest incidence in Croatia, to the sequellae of migrations during military activities in Croatia and Bosnia (1991-1995) and to the post-war recession.

Prevalencia de infección tuberculosa y su relación con la clase social en niños de la Comunidad de Madrid

INTRODUCTION

The frequency of tuberculosis infection, particularly among children, indicates the magnitude of the disease reservoir. The aim of this study was to ascertain the prevalence of tuberculosis infection in children in the Autonomous Community of Madrid and its association with social class.

MATERIAL AND METHODS

We performed a cross sectional study of 6-year-old schoolchildren living in the Autonomous Community of Madrid, selected through probabilistic sampling. From September 1999 through June 2000, information was collected on residence stratum, tuberculin test (positivity threshold 5 mm), social class (five categories), based on the occupation of the main earner in the family, and the formal education attained by the parents. We calculated 95% confidence intervals for the prevalence estimates according to a Poisson distribution.

RESULTS

A total of 2,721 children were studied. The prevalence of tuberculosis infection for the total study population was 0.62% (95% CI: 0.29-0.95). The prevalence of tuberculosis infection was 0.42% (95% CI: 0.00-0.85) in social class I (the highest), 0.00% (95% CI: 0.00-1.17) in class II, 0.77% (95% CI: 0.00-1.86) in class III, 0.62% (95% CI: 0.00-1.32) in class IV, and 1.57% (95% CI: 0.00-3.40) in class V (the lowest). In both fathers and mothers, the highest prevalence of tuberculosis infection was found in the group that had only completed elementary school or basic general education (up to the age of 14).

CONCLUSIONS

The prevalence of tuberculosis infection in the Autonomous Community of Madrid is similar to that in others areas of Spain. The results of our study are consistent with a lower prevalence in the higher socioeconomic groups.

Risk factors for tuberculin skin test positivity in an industrial workforce results of a contact investigation

OBJECTIVE

The objective of this study was to determine the prevalence of and risk factors for tuberculin skin test (TST) positivity among an industrial workforce employing many foreign-born workers after one employee was hospitalized for active tuberculosis (TB).

METHODS

A contact investigation was performed. We used crude odds ratios and a multivariate model to assess risk factors for TST positivity.

RESULTS

The rate of TST positivity was 37.1% (N=97). Twenty-nine of 36 (80.6%) workers from higher TB prevalence countries versus seven of 61 (11.5%) workers born in low-prevalence countries were positive. Workplace risk factors included using the lunchroom, carpooling with the case, or working on the same or subsequent shift. A total of 66.7% of immigrant workers denied previous screening.

CONCLUSION

TB contact investigations should probe into workplace transmission. Workplaces with workers from higher TB prevalence countries should consider pre-placement TB screening.

Current issues in global tuberculosis control

Despite attempts to standardize tuberculosis (TB) control strategies, there remains wide variation in the selection and implementation of control strategies within and among nations. Some of this variation is appropriate; based on wide variations in the available resources, the prevalence of TB infection, the incidence of TB disease, the relative contribution of reactivation versus recent transmission to incident cases, and the rate of HIV co-infection. This review will discuss three controversial questions relevant to global TB control: (1) What is the role of the treatment of latent TB infection in global TB control? (2) What are successful strategies to control immigrant TB in low incidence countries? (3) What are successful strategies to control TB in persons with HIV infection?

Tuberculosis infection in HIV-infected Indian patients

Individuals with HIV infection are at increased risk for tuberculosis (TB). The altered CD4 T-cell homeostasis induced by HIV infection may play a key role in the development of tuberculosis in HIV-infected patients. In this retrospective analysis, lymphocyte profiles (CD4 and CD8 count) of subjects infected with HIV, with or without TB, were evaluated. The influence of tuberculosis treatment on the CD4 count in dually infected patients was analyzed in a subset of patients available for follow-up. Of 421 subjects with HIV infection studied, 105 (24.9%) were positive for TB (HIV+TB+). A statistically significant difference (p = 0.0001) was found in the median CD4+ counts between the HIV+TB- (297.5 per microliter) and HIV+TB+ (181 per microliter) groups. TB was found to be the indicator disease for HIV infection in 36 (34.2%). In 65.7% of HIV-infected patients, TB was the first AIDS-defining disease. Of 72 patients who were receiving TB treatment, 33 (45.9%) showed an increase in CD4 counts, but this was statistically not significant. None of these patients was undergoing antiretroviral therapy prior to TB treatment. We conclude from this retrospective study that TB, a common HIV-related opportunistic infection in Indian subjects, is associated with lower CD4+ counts. The influence of TB therapy on CD4 counts in the patients needs to be further investigated.