Tuberculosis and Race/Ethnicity in the United States

Abstract

Despite the long-standing observation that tuberculosis (TB) case rates are higher among racial and ethnic minorities than whites in the United States (U.S.), the proportion of this increased risk attributable to socioeconomic status (SES) has not been determined. Values for six SES indicators (crowding, income, poverty, public assistance, unemployment, and education) were assigned to U.S. TB cases reported from 1987-1993 by ZIP code- and demographic-specific matching to 1990 U.S. Census data. TB risk between racial/ethnic groups was then evaluated by quartile for each SES indicator utilizing univariate and Poisson multivariate analyses. Relative risk (RR) of TB increased with lower SES quartile for all six SES indicators on univariate analysis (RRs 2.6-5.6 in the lowest versus highest quartiles). The same trend was observed in multivariate models containing individual SES indicators (RRs 1.8-2.5) and for three SES indicators (crowding, poverty, and education) in the model containing all six indicators. Tuberculosis risk increased uniformly between SES quartile for each indicator except crowding, where risk was concentrated in the lowest quartile. Adjusting for SES accounted for approximately half of the increased risk of TB associated with race/ethnicity among U.S.-born blacks, Hispanics, and Native Americans. Even more of this increased risk was accounted for in the final model, which also adjusted for interaction between crowding and race/ethnicity. SES impacts TB incidence via both a strong direct effect of crowding, manifested predominantly in overcrowded settings, and a TB-SES health gradient, manifested at all SES levels. SES accounts for much of the increased risk of TB previously associated with race/ethnicity.

Zip code-level risk factors for tuberculosis: neighborhood environment and residential segregation in New Jersey, 1985-1992

“…In agreement with the only previous zip code-level study of TB among US minorities, 6 we generally found an increase in exposure to risk factors, contact with immigrants, isolation, and density as we moved from no TB to very high TB zip codes. However, these gradients varied by racial/ethnic group.…”

“…Considerable historical and contemporary evidence indicates that TB is positively associated with low socioeconomic status (e.g., poverty) 5,6,8,[15][16][17] and substandard housing conditions (e.g., crowding and dilapidation). [18][19][20] Residential segregation may have an indirect effect on TB trans- [1985][1986][1987][1988][1989][1990][1991][1992] Note.…”

“…1 As in the rest of the United States, in New Jersey TB is geographically concentrated in urban areas (Figure 1) and disproportionately affects racial/ ethnic minorities. 2 Despite the observation that TB historically has been associated with environmental etiologies, [3][4][5] with some exceptions 6 little attention has been given to the role of environmental factors in explaining the disproportionately high TB incidence among US minorities. 7 Individual-level factors (e.g., a history of alcoholism or HIV infection) may make an individual more susceptible to TB.…”

Tuberculose em populações indígenas de Rondônia, Amazônia, Brasil

“…Os segmentos populacionais socioeconomicamente menos favorecidos são aqueles que tendem a apresentar maior vulnerabilidade à tuberculose (Cantwell et al, 1998;Elen-der et al, 1998). Os resultados obtidos a partir da análise do banco de dados do PCT-RO estão de acordo com a literatura, no sentido de apontar os grupos indígenas como mais vulneráveis à tuberculose.…”

Sociocultural dimensions of tuberculosis: an overview of key concepts

“…23,24 Genetic differences undoubtedly have a role in susceptibility to active TB infection, but ascription of the influence of race or ethnicity to susceptibility to TB remains, at best, controversial, 25 especially as other correlates such as socioeconomic status can also explain why some populations have higher incidence of infection. 26,27 Yet social inequality in disease is only partially explained by the classic behavioural dimension of health risk exposure. Structural conditions can perpetrate violence against distinct populations by preventing them from meeting their most basic needs.…”