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Contextualizing tuberculosis risk in time and space: comparing time-restricted genotypic case clusters and geospatial clusters to evaluate the relative contribution of recent transmission to incidence of TB using nine years of case data from Michigan, USA. Ann Epidemiol 2019; 40:21-27.e3. [PMID: 31711839 DOI: 10.1016/j.annepidem.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/11/2019] [Accepted: 10/02/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE Novel approaches must address the underlying factors sustaining the tuberculosis (TB) epidemic in the United States, specifically what maintains new Mycobacterium tuberculosis (Mtb) transmission. METHODS Culture-confirmed TB cases reported to the Michigan Department of Health and Human Services (2004-2012) were analyzed for time-restricted genotypic and/or geospatial clustering. Cases with both types of clustering were used as a proxy for recent, local transmission. Modified, multivariate Poisson regression models were fit to estimate this prevalence in relation to various individual- and neighborhood-level demographic and socio-economic variables. RESULTS Those individuals that were spatially clustered were 1.7 times as likely to also be time-restricted genotypically clustered. The prevalence of recent, local transmission was higher among U.S.-born cases, males, and non-Hispanic blacks. Moreover, people living in neighborhoods in the highest poverty quartile had 13.8 times the prevalence of recent, local transmission compared with those in the lowest poverty neighborhoods. CONCLUSIONS Our results suggest geographic areas with high concentration of TB cases are likely driven by ongoing transmission, rather than enclaves of individuals who have reactivated a case of latent TB. Furthermore, efforts to continue reducing Mtb transmission in the United States, and other low-incidence settings, must better identify community-level sources of risk, manifested through the complex social interactions among people and their environments.
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Narayanan N, Gulati N, Ghoshal B, Feja K, Malhotra A, Bhavaraju R, Jindani A, Gaur S, Kalyoussef S. Latent Tuberculosis Infection Beliefs and Testing and Treatment Health Behaviors Amongst Non-US-Born South Asians in New Jersey: A Cross-Sectional Community Survey. J Community Health 2018; 44:796-804. [PMID: 30560311 DOI: 10.1007/s10900-018-00607-4] [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: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Navaneeth Narayanan
- Rutgers University, Ernest Mario School of Pharmacy, 160 Frelinghuysen Road, Piscataway, NJ, 08854, USA. .,Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA. .,Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA.
| | - Nupur Gulati
- Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA
| | - Bishakha Ghoshal
- Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA
| | - Kristina Feja
- Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA.,The Children's Hospital at St. Peter's University Hospital, 254 Easton Avenue, New Brunswick, NJ, 08901, USA
| | - Amisha Malhotra
- Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA
| | - Rajita Bhavaraju
- Global Tuberculosis Institute, Rutgers University, 225 Warren Street, Newark, NJ, 07103, USA
| | - Arpita Jindani
- Global Tuberculosis Institute, Rutgers University, 225 Warren Street, Newark, NJ, 07103, USA
| | - Sunanda Gaur
- Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA
| | - Sabah Kalyoussef
- Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA.,The Children's Hospital at St. Peter's University Hospital, 254 Easton Avenue, New Brunswick, NJ, 08901, USA
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Noppert GA, Wilson ML, Clarke P, Ye W, Davidson P, Yang Z. Race and nativity are major determinants of tuberculosis in the U.S.: evidence of health disparities in tuberculosis incidence in Michigan, 2004-2012. BMC Public Health 2017; 17:538. [PMID: 28578689 PMCID: PMC5457589 DOI: 10.1186/s12889-017-4461-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 05/23/2017] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Grace A Noppert
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.,Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Mark L Wilson
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Philippa Clarke
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Wen Ye
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Peter Davidson
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Zhenhua Yang
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
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Noppert GA, Yang Z, Clarke P, Ye W, Davidson P, Wilson ML. Individual- and neighborhood-level contextual factors are associated with Mycobacterium tuberculosis transmission: genotypic clustering of cases in Michigan, 2004-2012. Ann Epidemiol 2017; 27:371-376.e5. [PMID: 28571914 PMCID: PMC5583706 DOI: 10.1016/j.annepidem.2017.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/10/2017] [Accepted: 05/05/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE Using genotyping data of Mycobacterium tuberculosis isolates from new cases reported to the tuberculosis (TB) surveillance program, we evaluated risk factors for recent TB transmission at both the individual- and neighborhood- levels among U.S.-born and foreign-born populations. METHODS TB cases (N = 1236) reported in Michigan during 2004 to 2012 were analyzed using multivariable Poisson regression models to examine risk factors for recent transmission cross-sectionally for U.S.-born and foreign-born populations separately. Recent transmission was defined based on spoligotype and 12-locus-mycobacterial interspersed repetitive unit-variable number tandem repeat typing matches of bacteria from cases that were diagnosed within 1 year of each other. Four classes of predictor variables were examined: demographic factors, known TB risk factors, clinical characteristics, and neighborhood-level factors. RESULTS Overall, 22% of the foreign-born cases resulted from recent transmission. Among the foreign-born, race and being a contact of an infectious TB case were significant predictors of recent transmission. More than half (52%) of U.S.-born cases resulted from recent transmission. Among the U.S.-born, recent transmission was predicted by both individual- and neighborhood-level sociodemographic characteristics. CONCLUSIONS Interventions aimed at reducing TB incidence among foreign-born should focus on reducing reactivation of latent infection. However, reducing TB incidence among the U.S.-born will require decreasing transmission among socially disadvantaged groups at the individual- and neighborhood- levels. This report fills an important knowledge gap regarding the contemporary social context of TB in the United States, thereby providing a foundation for future studies of public health policies that can lead to the development of more targeted, effective TB control.
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Affiliation(s)
- Grace A Noppert
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
| | - Zhenhua Yang
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Philippa Clarke
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor; Institute for Social Research, University of Michigan, Ann Arbor
| | - Wen Ye
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Peter Davidson
- Michigan Department of Health and Human Services, Lansing, MI
| | - Mark L Wilson
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
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