Comparing factors for recent transmission of tuberculosis by country of origin -- United States, 2011-2014 Open Access

Marks, Kala (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/f7623c777?locale=en
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Abstract

Marginalizing conditions, such as homelessness, alcohol use, illicit drug use, and incarceration, have been well established as risk factors for recent transmission of tuberculosis (TB) among U.S.-born cases but have not been well studied among foreign-born cases. Thus, we sought to 1) determine if marginalizing conditions were associated with recent transmission among foreign-born persons in the United States, and 2) to test whether these associations significantly differed between U.S.-born and foreign-born cases. We conducted a nation-wide study using genotyped cases reported to the National TB Surveillance System during January 2011-September 2014. We estimated recent transmission using a novel field-validated plausible source-case approach and used log-binomial regression to evaluate the associations between recent transmission and each of the marginalizing conditions by local and foreign birth. Of the 26,562 analyzed cases, 3,820 (14%) were attributable to recent transmission, including 2,522 of 9,199 (27%) U.S.-born cases and 1,298 of 17,363 (8%) foreign-born cases. Among foreign-born TB cases, recent transmission was positively associated with homelessness (adjusted prevalence ratio [aPR] = 1.7; 95% confidence interval [CI] = 1.4, 2.2), illicit drug use (aPR = 1.4; 95% CI = 1.1, 1.8), and excessive alcohol use (aPR = 1.3; 95% CI = 1.1, 1.6), and negatively associated with incarceration at diagnosis (aPR = 0.5; 95% CI = 0.3, 0.7) after controlling for age (broad age categories) and race/ethnicity. Aside from incarceration at diagnosis, which was more negatively associated with recent transmission among foreign-born persons, there was no evidence to suggest that these associations significantly differed by origin of birth (p>0.05). Our results reiterate the need for improved TB control strategies among marginalized populations in the United States and show that marginalizing conditions are important factors for transmission regardless of local or foreign birth.

Table of Contents

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

Methods...................................................................................................................................................3

Results.....................................................................................................................................................6

Discussion................................................................................................................................................9

References..............................................................................................................................................16

Tables and Figures...................................................................................................................................20

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