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
About this Master's Thesis
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