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

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][2005][2006][2007][2008][2009][2010][2011][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.

How do social-economic differences in urban areas affect tuberculosis mortality in a city in the tri-border region of Brazil, Paraguay and Argentina

“…A study performed in Michigan (USA) also highlighted the disparity in the incidence of TB cases when comparing races and nationalities. In this study, black people had a mean incidence rate 25 times higher than whites and Asians had an incidence rate 19 times higher than whites [ 50 ]. These data demonstrate that TB illness and death are also socially modelled.…”

Individual- and neighborhood-level contextual factors are associated with Mycobacterium tuberculosis transmission: genotypic clustering of cases in Michigan, 2004–2012

“…In 2012, Michigan had an annual incidence rate of 1.28 TB cases per 100,000 [17], notably lower than the U.S. national average incidence of 3.2 per 100,000 [4]. Despite Michigan’s lower incidence, there is evidence of persistent disparities in TB risk, particularly by race and nativity [17].…”

“…Despite Michigan’s lower incidence, there is evidence of persistent disparities in TB risk, particularly by race and nativity [17]. Using TB surveillance data collected by the Michigan Department of Health and Human Services (MDHHS), we evaluated risk factors for recent transmission at both the individual- and neighborhood-levels among U.S.-born and foreign-born populations separately.…”

Polymorphisms in TLR4 and TNFA and Risk of Mycobacterium tuberculosis Infection and Development of Active Disease in Contacts of Tuberculosis Cases in Brazil: A Prospective Cohort Study

“…Initial LTBI was associated with nonwhite ethnicity and with the presence of cavity on chest radiograph of the index case. Nonwhite ethnicity has been found as a risk factor for extrapulmonary TB [31], but in our study, this characteristic may be a proxy variable for socioeconomic conditions in Brazil, reflecting crowding and higher community exposure.…”