Race and nativity are major determinants of tuberculosis in the US: evidence of health disparities in tuberculosis incidence in Michigan, 2004-2012
Race and nativity are major determinants of tuberculosis in the US: evidence of health disparities in tuberculosis incidence in Michigan, 2004-2012
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DOI：
10.1186/s12889-017-4461-y
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发表时间：
2017-06-02
影响因子：
4.5
通讯作者：
Yang, Zhenhua
中科院分区：
文献类型：
--
作者：
Noppert, Grace A.;Wilson, Mark L.;Yang, Zhenhua
背景：2012年，密歇根州的结核病发病率为每10万人1.5人，大约是美国发病率的一半。尽管在结核病控制方面取得了成功，但密歇根州在结核病方面仍然存在差异，特别是在种族、年龄和出生地方面。理解结核病负担差异的一个主要挑战是区分由最近传播引起的结核病病例和由潜伏的结核病感染重新激活引起的结核病病例，这些信息对制定控制战略至关重要。我们研究了密歇根州全体人口和人口亚组内结核病(TB)发病模式的九年趋势。方法：使用结核病监测数据的横断面研究，我们分析了2004-2012年密歇根州报告的1254例结核病病例。病例包括那些同时获得SPOGO分型和12位点-MIU-VNTR结果的患者。利用基因分型信息和诊断时间的组合，我们将病例分类为最近传播或重新激活潜伏性结核病感染所致。我们使用多变量负二项回归模型研究了整个人群以及按种族、出生地、性别和年龄划分的结核病发病率的趋势。结果：总体而言，结核病发病率平均每年下降8%--在新发病例中为11%，在新发病例中为9%。在控制出生、性别和年龄后，对于最近传播的疾病，黑人的平均发病率是白人的25倍。在控制了出生、性别和年龄因素后，由潜在结核病感染引起的疾病，亚洲人的平均发病率是白人的24倍。结论：尽管结核病控制工作仍在进行，但发病率的差异仍然存在。在种族和出生方面观察到了更大的差异，这表明了结核病发病率的一些社会模式。缩小这些差距将需要多方面的办法，包括高危人群的社会和环境背景。
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.