A Comparative Analysis in the Annual Rate of Change in US-born Non-Hispanic Black and US-born Non-Hispanic White Tuberculosis Cases, 1993-2011 Open Access
Cope, Jeffrey Scott (2013)
Abstract
Background: Tuberculosis in the United States remains a major public health problem as prevention efforts have failed to reach previous goals of elimination. Despite this, annual CDC reports have shown US-born TB cases declining since 1993. In particular, US-born non-Hispanic black TB cases have declined dramatically since 2007. Objective: The purpose of this study is to analyze the US-born non-Hispanic black TB case counts to determine if a) the sharper decline since 2007 is significant and b) if this decline is significantly different from the US-born white TB case count in the same time period. Case counts are analyzed here instead of incidence rates due to the amount of burden TB has on health program resources and its significant treatment time (~12 months). Methods: Data collected from 1993-2011 as part of the National Tuberculosis Surveillance System (NTSS) was used to compare US-born black and white TB cases. Using JoinPoint 4.0.4 software and its spline/knot algorithm, graphs were generated to determine average annual percent change (APC) and SAS was incorporated to confirm the estimates that JoinPoint produced. Results: From 1993 to 2011, there were 312,620 cases of reported TB in the United States, 53.5% (n=167,260) were US-born in origin. Of the US-born, black and white TB cases represented 45.92% (n=76,803) and 35.5% (n=59,374), respectively. JoinPoint's spline algorithm determined that there were two join points over the 19 year period in US-born black TB data (2002, 2007) and only one join point in US-born whites (2002). These join points delineated a significant change in the average APC and were affirmed through Poisson regression analysis in SAS. Relevant risk factors were also stratified in JoinPoint, searching for differences in trends of TB among US-born non-Hispanic blacks categorized at different levels of risk factors. Conclusion: The decline in US-born black TB cases since 2007 was significant compared to previous years and to US-born white TB cases in the same time period. A few risk factors associated with TB shared a similar pattern with the average APC changes in US-born black TB cases including specific age groups, type of therapy, and place of therapy.
Table of Contents
CHAPTER I: LITERATURE REVIEW…………………………………………………1 1. Burden/Infection………………………………………………………………1 2. Detection/Treatment……………………………………………………….2 3. Risk Factors/Ethnic Groups………………………………………………3 4. Drug Resistance TB………………………………………………………...5 5. The Question...………………………………………………………………..6 6. Analysis Software…………………………………………………………….7 CHAPTER II: MANUSCRIPT…………………………………………………………...9 1. Introduction…………………………………………………………..………..9 2. Methods………………………………………………………………….……...10 3. Results…………………………………………………………………...……...14 4. Discussion……………………………………………………………………....16 5. Strengths/Weaknesses……………………………………………………17 CHAPTER III: Broader Perspective…………………………………………………20 1. Study Critique………………………………………………………..………..20 2. TB Relationship with Economy……………………..………………….21 3. Refocusing on Foreign-born TB………………………………………..22 CONCLUSION…………………………………………………………………………….....26 REFERENCES……………………………………………………………………………......27 TABLES & FIGURES..…………………………………………………………………....30
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