1
|
Swartwood NA, Li Y, Regan M, Marks SM, Barham T, Beeler Asay GR, Cohen T, Hill AN, Horsburgh CR, Khan AD, McCree DH, Myles RL, Salomon JA, Self JL, Menzies NA. Estimated Health and Economic Outcomes of Racial and Ethnic Tuberculosis Disparities in US-Born Persons. JAMA Netw Open 2024; 7:e2431988. [PMID: 39254977 PMCID: PMC11388029 DOI: 10.1001/jamanetworkopen.2024.31988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
Importance Despite significant progress made toward tuberculosis (TB) elimination, racial and ethnic disparities persist in TB incidence and case-fatality rates in the US. Objective To estimate the health outcomes and economic cost of TB disparities among US-born persons from 2023 to 2035. Design, Setting, and Participants Generalized additive regression models projecting trends in TB incidence and case-fatality rates from 2023 to 2035 were fit based on national TB surveillance data for 2010 to 2019 in the 50 US states and the District of Columbia among US-born persons. This baseline scenario was compared with alternative scenarios in which racial and ethnic disparities in age- and sex-adjusted incidence and case-fatality rates were eliminated by setting rates for each race and ethnicity to goal values. Additional scenarios were created examining the potential outcomes of delayed reduction of racial and ethnic disparities. The potential benefits of eliminating disparities from differences between baseline and alternative scenario outcomes were quantified. Data were analyzed from January 2010 to December 2019. Exposures Non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, non-Hispanic Black, Hispanic, non-Hispanic Native Hawaiian or Other Pacific Islander, or non-Hispanic White race and ethnicity. Main outcomes and measures TB cases and deaths averted, quality-adjusted life years gained, and associated costs from a societal perspective. Results The study included 31 811 persons with reported TB from 2010 to 2019 (mean [SD] age, 47 [24] years; 20 504 [64%] male; 1179 [4%] American Indian or Alaska Native persons; 1332 [4%] Asian persons; 12 152 [38%] Black persons; 6595 [21%] Hispanic persons; 299 [1%] Native Hawaiian or Other Pacific Islander persons; and 10 254 [32%] White persons). There were 3722 persons with a reported TB death. Persistent racial and ethnic disparities were associated with an estimated 11 901 of 26 203 TB cases among US-born persons (45%; 95% uncertainty interval [UI], 44%-47%), 1421 of 3264 TB deaths among US-born persons (44%; 95% UI, 39%-48%), and an economic cost of $914 (95% UI, $675-$1147) million from 2023 to 2035. Delayed goal attainment reduced the estimated avertable TB outcomes by 505 (95% UI, 495-518) TB cases, 55 (95% UI, 51-59) TB deaths, and $32 (95% UI, $24-$40) million in societal costs annually. Conclusions and relevance In this modeling study of racial and ethnic disparities of TB, these disparities were associated with substantial future health and economic outcomes of TB among US-born persons without interventions beyond current efforts. Actions to eliminate disparities may reduce the excess TB burden among these persons and may contribute to accelerating TB elimination within the US.
Collapse
Affiliation(s)
| | - Yunfei Li
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mathilda Regan
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Suzanne M Marks
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Terrika Barham
- Office of Health Equity, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Garrett R Beeler Asay
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ted Cohen
- Yale School of Public Health, New Haven, Connecticut
| | - Andrew N Hill
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charles R Horsburgh
- Boston University Schools of Public Health and Medicine, Departments of Epidemiology, Biostatistics, Global Health and Medicine, Boston, Massachusetts
| | - Awal D Khan
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Donna Hubbard McCree
- Office of Health Equity, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ranell L Myles
- Office of Health Equity, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joshua A Salomon
- Center for Health Policy, Stanford University, Stanford, California
| | - Julie L Self
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | |
Collapse
|
2
|
Humayun M, Mukasa L, Ye W, Bates JH, Yang Z. Racial and Ethnic Disparities in Tuberculosis Incidence, Arkansas, USA, 2010-2021. Emerg Infect Dis 2024; 30:116-124. [PMID: 38146997 PMCID: PMC10756389 DOI: 10.3201/eid3001.230778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
We conducted an epidemiologic assessment of disease distribution by race/ethnicity to identify subpopulation-specific drivers of tuberculosis (TB). We used detailed racial/ethnic categorizations for the 932 TB cases diagnosed in Arkansas, USA, during 2010-2021. After adjusting for age and sex, racial/ethnic disparities persisted; the Native Hawaiian/Pacific Islander (NHPI) group had the highest risk for TB (risk ratio 173.6, 95% CI 140.6-214.2) compared with the non-Hispanic White group, followed by Asian, Hispanic, and non-Hispanic Black. Notable racial/ethnic disparities existed across all age groups; NHPI persons 0-14 years of age were at a particularly increased risk for TB (risk ratio 888, 95% CI 403-1,962). The risks for sputum smear-positive pulmonary TB and extrapulmonary TB were both significantly higher for racial/ethnic minority groups. Our findings suggest that TB control in Arkansas can benefit from a targeted focus on subpopulations at increased risk for TB.
Collapse
|
3
|
Regan M, Li Y, Swartwood NA, Barham T, Asay GRB, Cohen T, Hill AN, Horsburgh CR, Khan A, Marks SM, Myles RL, Salomon JA, Self JL, Menzies NA. Racial and ethnic disparities in diagnosis and treatment outcomes among US-born people diagnosed with tuberculosis, 2003-19: an analysis of national surveillance data. Lancet Public Health 2024; 9:e47-e56. [PMID: 38176842 DOI: 10.1016/s2468-2667(23)00276-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/21/2023] [Accepted: 11/01/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Persistent racial and ethnic disparities in tuberculosis incidence exist in the USA, however, less is known about disparities along the tuberculosis continuum of care. This study aimed to describe how race and ethnicity are associated with tuberculosis diagnosis and treatment outcomes. METHODS In this analysis of national surveillance data, we extracted data from the US National Tuberculosis Surveillance System on US-born patients with tuberculosis during 2003-19. To estimate the association between race and ethnicity and tuberculosis diagnosis (diagnosis after death, cavitation, and sputum smear positivity) and treatment outcomes (treatment for more than 12 months, treatment discontinuation, and death during treatment), we fitted log-binomial regression models adjusting for calendar year, sex, age category, and regional division. Race and ethnicity were defined based on US Census Bureau classification as White, Black, Hispanic, Asian, American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and people of other ethnicities. We quantified racial and ethnic disparities as adjusted relative risks (aRRs) using non-Hispanic White people as the reference group. We also calculated the Index of Disparity as a summary measure that quantifies the dispersion in a given outcome across all racial and ethnic groups, relative to the population mean. We estimated time trends in each outcome to evaluate whether disparities were closing or widening. FINDINGS From 2003 to 2019, there were 72 809 US-born individuals diagnosed with tuberculosis disease of whom 72 369 (35·7% women and 64·3% men) could be included in analyses. We observed an overall higher risk of any adverse outcome (defined as diagnosis after death, treatment discontinuation, or death during treatment) for non-Hispanic Black people (aRR 1·27, 95% CI 1·22-1·32), Hispanic people (1·20, 1·14-1·27), and American Indian or Alaska Native people (1·24, 1·12-1·37), relative to non-Hispanic White people. The Index of Disparity for this summary outcome remained unchanged over the study period. INTERPRETATION This study, based on national surveillance data, indicates racial and ethnic disparaties among US-born tuberculosis patients along the tuberculosis continuum of care. Initiatives are needed to reduce diagnostic delays and improve treatment outcomes for US-born racially marginalised people in the USA. FUNDING US Centers for Disease Control and Prevention.
Collapse
Affiliation(s)
- Mathilda Regan
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Yunfei Li
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Nicole A Swartwood
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Terrika Barham
- Office of Health Equity, National Center for HIV, Viral Hepatitis, STD, and TB prevention, US Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - Garrett R Beeler Asay
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB prevention, US Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - Ted Cohen
- Yale School of Public Health, New Haven, CT, USA
| | - Andrew N Hill
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB prevention, US Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - C Robert Horsburgh
- Departments of Epidemiology, Biostatistics, Global Health, and Medicine, Boston University Schools of Public Health and Medicine, Boston, MA, USA
| | - Awal Khan
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB prevention, US Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - Suzanne M Marks
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB prevention, US Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - Ranell L Myles
- Office of Health Equity, National Center for HIV, Viral Hepatitis, STD, and TB prevention, US Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - Joshua A Salomon
- Department of Health Policy, Stanford University, Stanford, CA, USA
| | - Julie L Self
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB prevention, US Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
4
|
Ayala A, Ncogo P, Eyene J, García B, Benito A, Romay-Barja M. Rural-Urban Inequities in Tuberculosis-Related Practices in Equatorial Guinea. J Epidemiol Glob Health 2023; 13:886-894. [PMID: 37870720 PMCID: PMC10686923 DOI: 10.1007/s44197-023-00162-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 10/15/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is one of the leading causes of mortality from a single infectious disease agent. Equatorial Guinea is a country with high estimated TB incidence in 2021 (275 cases per 100,000 population) and low TB case detection (42%). Early diagnosis and prompt treatment are crucial for TB control. Failure to seek adequate health care increases the disease's transmission and leads to poor treatment outcome, the mortality, even for easily manageable conditions. Information regarding community management of TB and treatment-seeking patterns in Equatorial Guinea is rare. The aim of this study was to explore differences in TB health-seeking behaviour among urban and rural population TB cases in Equatorial Guinea and the factors associated with this behaviour. METHODS A national cross-sectional study of 770 household caregivers was conducted in 2020 in Equatorial Guinea using multistage stratified sampling. The 284 caregivers that reported having had a TB case in their family were included in this study. A practice index was created. Poisson regression with robust variance was performed with the practices index as dependent variable to assess the factors associated with the health-seeking behaviour. RESULTS Most of the cases (65%) have had good TB health-seeking practices. However, 23.2% of TB cases reported having abandoned treatment before 6 months. A higher probability of having good TB practices was observed with being women, aged and living in rural area. Those who were TB cases themselves have heard about TB on the radio, and had high knowledge about TB, hand also good practices. CONCLUSIONS Disparities in tuberculosis health-seeking behaviour between rural and urban populations highlight the challenges existing in the fight against this infectious disease. The National Tuberculosis Control Program has to reinforce the health system needs to strengthen the follow-up of TB patients taking into account the population at risk of inappropriate TB behaviour. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Alba Ayala
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
| | - Policarpo Ncogo
- Fundación Estatal, Salud, Infancia y Bienestar Social (FCSAI), Madrid, Spain
| | - Juan Eyene
- Ministerio de Salud y Bienestar Social, Malabo, Equatorial Guinea
| | - Belén García
- Fundación Estatal, Salud, Infancia y Bienestar Social (FCSAI), Madrid, Spain
| | - Agustín Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - María Romay-Barja
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
| |
Collapse
|
5
|
Detelich JF, Kempker JA. Respiratory Infections. Clin Chest Med 2023; 44:509-517. [PMID: 37517831 DOI: 10.1016/j.ccm.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Pneumonia is one of the most common reasons for health care utilization in the United States. It can be caused by many different pathogens, but rarely is it able to be identified in specific cases. This has led most racial disparities research to focus on community acquired pneumonia and microbes of public health concern such as influenza, tuberculosis, and COVID-19. Differences have been shown to exist from prevention with vaccines to management and outcomes. COVID-19 has led to a significant increase in the awareness of this topic.
Collapse
Affiliation(s)
- Joshua F Detelich
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, 615 Michael Street. Ste 205, Atlanta, GA 30322, USA.
| | - Jordan A Kempker
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, 615 Michael Street. Ste 205, Atlanta, GA 30322, USA
| |
Collapse
|
6
|
Preuc C, Humayun M, Yang Z. Varied trends of tuberculosis and HIV dual epidemics among different countries during 2000-2020: lessons from an ecological time-trend study of 9 countries. Infect Dis (Lond) 2023; 55:567-575. [PMID: 37345429 DOI: 10.1080/23744235.2023.2223272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND While Human Immunodeficiency Virus (HIV) infection is a well-established risk factor for tuberculosis (TB), the effect of HIV infection on TB incidence varies across countries given differences in local epidemiological factors and disparate progress with respect to TB elimination goals. METHODS In this descriptive epidemiological study, we explored the country-specific associations between HIV prevalence and TB incidence in nine countries representing four WHO regions using data between 2000 and 2020. For each of these countries, we (1) described the trends of TB incidence and HIV prevalence, and (2) examined country-level associations between TB incidence and HIV prevalence, using negative binomial regression. RESULTS The trends of TB incidence and HIV prevalence, and the country-level associations, varied across the study countries. Angola, Thailand and Zimbabwe showed parallel TB incidence and HIV prevalence trends while the two trends diverged in Brazil, Liberia and Indonesia during the study period. Additionally, the strength of association between HIV prevalence and TB incidence varied widely between countries, with the risk ratio ranging from 0.42 (95% CI: 0.36, 0.49) in Indonesia to 2.78 (95% CI: 2.57, 3.02) in Thailand. CONCLUSIONS The association of HIV infection with TB incidence varied across high burden settings, suggesting that HIV is not a ubiquitous driver of TB incidence. Without acknowledging the local drivers of TB epidemics across countries, the END TB Strategy cannot be adapted at the country level. The findings from this analysis can inform the design of future studies to identify country-specific drivers of TB using individual-level data.
Collapse
Affiliation(s)
- Chelsi Preuc
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Maheen Humayun
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Zhenhua Yang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
7
|
Association of Sociodemographic Factors with Tuberculosis Outcomes in Mississippi. Diseases 2023; 11:diseases11010025. [PMID: 36810538 PMCID: PMC9944444 DOI: 10.3390/diseases11010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Tuberculosis (TB) is one of the leading causes of death worldwide. In the US, the national incidence of reported TB cases was 2.16 per 100,000 persons in 2020 and 2.37 per 100,000 persons in 2021. Furthermore, TB disproportionately affects minorities. Specifically, in 2018, 87% of reported TB cases occurred in racial and ethnic minorities in Mississippi. Data from TB patients from the Mississippi Department of Health (2011-2020) were used to examine the association between sociodemographic subgroups (race, age, place of birth, gender, homelessness, and alcohol use) with TB outcome variables. Of the 679 patients with active TB cases in Mississippi, 59.53% were Black, and 40.47% were White. The mean age was 46 ± ten years; 65.1% were male, and 34.9% were female. Among patients with previous TB infections, 70.8% were Black, and 29.2% were White. The rate of previous TB cases was significantly higher among US-born (87.5%) persons compared with non-US-born persons (12.5%). The study suggested that sociodemographic factors play a significant role in TB outcome variables. This research will help public health professionals to develop an effective TB intervention program that addresses sociodemographic factors in Mississippi.
Collapse
|
8
|
Roberts EK, Gu T, Wagner AL, Mukherjee B, Fritsche LG. Estimating COVID-19 Vaccination and Booster Effectiveness Using Electronic Health Records From an Academic Medical Center in Michigan. AJPM FOCUS 2022; 1:100015. [PMID: 36942016 PMCID: PMC9323299 DOI: 10.1016/j.focus.2022.100015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction Observational studies of COVID-19 vaccines' effectiveness can provide crucial information regarding the strength and durability of protection against SARS-CoV-2 infection and whether the protective response varies across different patient subpopulations and in the context of different SARS-CoV-2 variants. Methods We used a test-negative study design to assess vaccine effectiveness against SARS-CoV-2 infection and severe COVID-19 resulting in hospitalization, intensive care unit admission, or death using electronic health records data of 170,741 adults who had been tested for COVID-19 at the University of Michigan Medical Center between January 1 and December 31, 2021. We estimated vaccine effectiveness by comparing the odds of vaccination between cases and controls during each 2021 calendar quarter and stratified all outcomes by vaccine type, patient demographic and clinical characteristics, and booster status. Results Unvaccinated individuals had more than double the rate of infections (12.1% vs 4.7%) and >3 times the rate of severe COVID-19 outcomes (1.4% vs 0.4%) than vaccinated individuals. COVID-19 vaccines were 62.1% (95% CI=60.3, 63.8) effective against a new infection, with protection waning in the last 2 quarters of 2021. The vaccine effectiveness against severe disease overall was 73.7% (95% CI=69.6, 77.3) and remained high throughout 2021. Data from the last quarter of 2021 indicated that adding a booster dose augmented effectiveness against infection up to 87.3% (95% CI=85.0, 89.2) and against severe outcomes up to 94.0% (95% CI=89.5, 96.6). Pfizer-BioNTech and Moderna vaccines showed comparable performance when controlling for vaccination timing. Vaccine effectiveness was greater in more socioeconomically affluent areas and among healthcare workers; otherwise, we did not detect any significant modification of vaccine effectiveness by covariates, including gender, race, and SES. Conclusions COVID-19 vaccines were highly protective against infection and severe COVID-19 resulting in hospitalization, intensive care unit admission, or death. Administration of a booster dose significantly increased vaccine effectiveness against both outcomes. Ongoing surveillance is required to assess the durability of these findings.
Collapse
Affiliation(s)
- Emily K. Roberts
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Center for Precision Health Data Science, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Tian Gu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Abram L. Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Bhramar Mukherjee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Center for Precision Health Data Science, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, Michigan
| | - Lars G. Fritsche
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Center for Precision Health Data Science, School of Public Health, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
9
|
Hubler A, Wakefield DV, Makepeace L, Carnell M, Sharma AM, Jiang B, Dove AP, Garner WB, Edmonston D, Little JG, Ozdenerol E, Hanson RB, Martin MY, Shaban-Nejad A, Pisu M, Schwartz DL. Independent Predictors for Hospitalization-Associated Radiotherapy Interruptions. Adv Radiat Oncol 2022; 7:101041. [PMID: 36158745 PMCID: PMC9489733 DOI: 10.1016/j.adro.2022.101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/24/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Radiation treatment interruption associated with unplanned hospitalization remains understudied. The intent of this study was to benchmark the frequency of hospitalization-associated radiation therapy interruptions (HARTI), characterize disease processes causing hospitalization during radiation, identify factors predictive for HARTI, and localize neighborhood environments associated with HARTI at our academic referral center. Methods and Materials This retrospective review of electronic health records provided descriptive statistics of HARTI event rates at our institutional practice. Uni- and multivariable logistic regression models were developed to identify significant factors predictive for HARTI. Causes of hospitalization were established from primary discharge diagnoses. HARTI rates were mapped according to patient residence addresses. Results Between January 1, 2015, and December 31, 2017, 197 HARTI events (5.3%) were captured across 3729 patients with 727 total missed treatments. The 3 most common causes of hospitalization were malnutrition/dehydration (n = 28; 17.7%), respiratory distress/infection (n = 24; 13.7%), and fever/sepsis (n = 17; 9.7%). Factors predictive for HARTI included African-American race (odds ratio [OR]: 1.48; 95% confidence interval [CI], 1.07-2.06; P = .018), Medicaid/uninsured status (OR: 2.05; 95% CI, 1.32-3.15; P = .0013), Medicare coverage (OR: 1.7; 95% CI, 1.21-2.39; P = .0022), lung (OR: 5.97; 95% CI, 3.22-11.44; P < .0001), and head and neck (OR: 5.6; 95% CI, 2.96-10.93; P < .0001) malignancies, and prescriptions >20 fractions (OR: 2.23; 95% CI, 1.51-3.34; P < .0001). HARTI events clustered among Medicaid/uninsured patients living in urban, low-income, majority African-American neighborhoods, and patients from middle-income suburban communities, independent of race and insurance status. Only the wealthiest residential areas demonstrated low HARTI rates. Conclusions HARTI disproportionately affected socioeconomically disadvantaged urban patients facing a high treatment burden in our catchment population. A complementary geospatial analysis also captured the risk experienced by middle-income suburban patients independent of race or insurance status. Confirmatory studies are warranted to provide scale and context to guide intervention strategies to equitably reduce HARTI events.
Collapse
Affiliation(s)
- Adam Hubler
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Daniel V. Wakefield
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
- Tennessee Oncology, Nashville, Tennessee
| | - Lydia Makepeace
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Matt Carnell
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Ankur M. Sharma
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Bo Jiang
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Austin P. Dove
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennesse
| | - Wesley B. Garner
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Drucilla Edmonston
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - John G. Little
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Esra Ozdenerol
- Department of Earth Sciences, University of Memphis, Memphis, Tennessee
| | - Ryan B. Hanson
- Department of Earth Sciences, University of Memphis, Memphis, Tennessee
| | - Michelle Y. Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Arash Shaban-Nejad
- UTHSC-ORNL Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, Tennesse
| | - Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - David L. Schwartz
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
- Corresponding author: David L. Schwartz, MD, FACR
| |
Collapse
|
10
|
Li H, Huang Q, Chen S, Zhang G, Shi S, Hua Wang, Li Y, Zhang T. The mRNA expression of visfatin and lipocalin-2 in peripheral blood mononuclear cells from patients with pulmonary tuberculosis. J Clin Lab Anal 2020; 34:e23476. [PMID: 32681594 PMCID: PMC7676204 DOI: 10.1002/jcla.23476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In this study, we aimed to assess mRNA expressions of visfatin and lipocalin-2 in peripheral blood mononuclear cells (PBMCs) from patients with pulmonary tuberculosis (PTB). METHODS Overall, 79 PTB patients and 71 healthy controls were enrolled. In PBMCs, mRNA expressions of visfatin and lipocalin-2 were detected using real-time quantitative polymerase chain reaction (qRT-PCR), and the diagnostic value of these adipokine mRNAs in PTB patients was calculated through receiver operating characteristic (ROC) analysis. RESULTS In PBMCs from PTB patients, the visfatin mRNA level was significantly higher than in healthy controls (P < .001), with no significant association between the lipocalin-2 mRNA level and PTB patients (P = .933). In PTB patients, lipocalin-2 mRNA expression positively correlated with the erythrocyte sedimentation rate (ESR) (P = .010). However, the visfatin mRNA level was not associated with any major clinical and laboratory parameter in PTB patients. The ROC curve demonstrated that visfatin could help distinguish PTB patients from healthy controls, with an optimal cutoff value of 0.645 and a corresponding sensitivity of 79.7%. CONCLUSIONS The altered visfatin mRNA expression indicated that this adipokine might play a role in PTB and could be an auxiliary biomarker for PTB diagnosis.
Collapse
Affiliation(s)
- Hong‐Miao Li
- Anhui Chest Hospital (Anhui Provincial TB Institute)HefeiChina
| | - Qian Huang
- Anhui Provincial Laboratory of Inflammatory and Immune DiseasesHefeiChina
| | | | - Gen‐You Zhang
- Anhui Chest Hospital (Anhui Provincial TB Institute)HefeiChina
| | - Si‐Jiu Shi
- Anhui Chest Hospital (Anhui Provincial TB Institute)HefeiChina
| | - Hua Wang
- Anhui Chest Hospital (Anhui Provincial TB Institute)HefeiChina
| | - Ye Li
- Anhui Chest Hospital (Anhui Provincial TB Institute)HefeiChina
| | - Tian‐Ping Zhang
- Department of Scientific ResearchThe First Affiliated Hospital of University of Science and Technology of ChinaHefeiChina
| |
Collapse
|