All ETDs from UAB

Advisory Committee Chair

Mary Ann B Pass

Advisory Committee Members

Russell R Kirby

Beverly A Mulvihill

Marilyn J Crain

Charles R Katholi

Document Type

Dissertation

Date of Award

2010

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

This study aimed to evaluate the role of individual and community/population level socioeconomic factors on racial/ethnic disparities among children and adults with TB, and used area-based socioeconomic measures (ABSMs) for the identification of high-risk geographic areas for populations-at-risk. Joinpoint, multivariable and Poisson regression, and spatial methods were used to determine the trends and risks of disease in a low TB incidence state. General disease trends declined significantly by factors of -0.044838 from 1993-1998, and -0.061821 from 2001-2007; but, were disparate and increased for the foreign-born, African Americans (AA) and Latinos, and in long-term care settings. The average annual percentage change (AAPC) in TB incidence for the foreign-born from 1993-2007 was significantly high (8.8 [95% CI = 2.7-15.3]), while an appreciable decrease in AAPC (-9.0 [95% CI = -13.0--4.9]) was experienced by the US born. Disease trends considerably declined in correctional settings and among the HIV co-infected. Latino children ages 0-14 were at greatest risk of TB (OR = 4.58 [95% CI = 2.76-7.61]), followed by AA children (OR = 2.48 [95% CI = 1.78-3.45]) compared to their White peers. Similar excess risks were observed for Latino, AA and Asian adults compared to Whites. Unemployment among TB cases in Alabama was significantly associated with disease for AAs and Asians. Completion of anti-TB therapy was higher for cases that received dual healthcare at health departments and with private physicians (OR = 1.33 [95% CI = 1.10-1.63]). Spoligotype families X and Beijing were predominantly observed among AAs and adults ages 25-64. Residential location was significantly associated with excess TB clustering risks that were geographically distinct for racial/ethnic, nativity and age groups; cluster relative risks ranged from 2.14-2.76 (p<.01) primarily in multiple census tracts of Jefferson, Tuscaloosa, Etowah, Madison and Mobile counties. ABSMs of poverty, high school incompletion, unemployment and crowding were associated with high risks of TB. Strategies for early detection of disease should include targeted area-based screening and the incorporation of socioeconomic factors in risk assessments, along with improved public-private partnerships and policy decisions to expand healthcare coverage for populations-at-risk to prevent every case of childhood TB and reduce disparities.

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