Epidemiology of Tuberculosis and Evaluation of Treatment Delay Among Foreign-Born Hispanic Persons in the United States Open Access

Lockard, Ann (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/6h440s73g?locale=en
Published

Abstract

Background

In 2012, 63% of cases of tuberculosis (TB) cases in the United States (U.S.) occurred among foreign-born persons, a third of whom were Hispanic. An understanding of the epidemiology of TB among foreign-born Hispanic persons is essential to progress in TB control and prevention. One area of interest is timely diagnosis and treatment of TB; delayed treatment initiation has been associated with worse health outcomes for the patient and increased transmission of the infection. The purpose of this study is first to describe the epidemiology of TB among Hispanic, foreign-born persons in the U.S. and second to identify factors associated with delay in treatment initiation.

Methods

A multi-site study in 2005-2007 recruited foreign-born persons newly diagnosed with TB. This secondary analysis included data only from participants who self-identified as Hispanic. Variables evaluated for association with treatment delay, defined as the interval between symptom onset and treatment initiation, included employment, education, English ability, usual source of medical care, place of diagnosis, self-efficacy (defined by answer to the question "do you think your own actions determine whether you be cured of tuberculosis?"), visa status, and time spent in the U.S. Cox proportional hazards models were used to assess association.

Results

Of the 568 cases included in the analysis, 61.3% were from Mexico, 54.4% were undocumented; 63.0% had a median income of less than $20,000, and 50.0% had less than an 8th grade education. Participants had a median treatment delay of 77.0 days. Those who arrived in the U.S. within two years of symptom onset had longer delay than those who arrived earlier [hazard ratio (HR)=0.69, 95% confidence interval (CI)=0.53,0.91]. Those who answered no to the self-efficacy question also had longer delays (HR=0.60, 95% CI=0.41, 0.87).

Discussion

Foreign-born Hispanic persons who have arrived recently have increased risk of treatment delay. In addition, persons who lack a sense of control over their TB outcomes have greater treatment delays. Approaches to reducing treatment delay could include removal of barriers to healthcare among recent arrivals to the U.S. and tailored public health messages to improve self-efficacy.

Table of Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Background and Literature Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

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