Uneven Burden: A Multivariate Analysis of Differences in Sociodemographic, Comorbid, Risk, and Case Management Factors in Tuberculosis Cases in Rural vs Urban, U.S. from 2014-2019  Open Access

Abstract

Although tuberculosis (TB) occurs less frequently in the U.S. than globally, it remains a significant public health concern. Limited research has explored differences between individuals with TB living in rural versus urban areas of the U.S. This study addresses that gap by examining patient characteristics, risk factors, comorbidities, and case management practices among individuals reported with TB from rural and urban states, in 2014–2019.  We used publicly available data from the CDC Wonder Online Tuberculosis Information System (OTIS) to acquire data from 14 states, categorized as urban or rural, during 2014-2019. Multivariate logistic regression analyses were conducted to assess differences in demographics, TB disease site, HIV status, treatment completion within one year, and receipt of directly observed therapy (DOT). Compared to individuals in urban states, those with TB in rural states were more likely to be male (OR = 1.217, CI: 1.089–1.359); aged 25–44 (OR = 2.315, CI: 1.872–2.863), 45–64 (OR = 1.539, CI: 1.290–1.968), or 65+ (OR = 1.784, CI: 1.432–2.222); have pulmonary TB (OR = 1.388, CI: 1.235–1.561); complete therapy within a year (OR = 1.143, CI: 0.928–1.409); and receive DOT (OR = 1.301, CI: 1.163–1.454). They were less likely to be non-U.S.-born (OR = 0.335, CI: 0.293–0.382); Asian (OR = 0.207, CI: 0.171–0.252), Black or African American (OR = 0.990, CI: 0.874–1.121), or Hispanic/Latino (OR = 0.132, CI: 0.110–0.159); and less likely to be HIV-positive (OR = 0.177, CI: 0.125–0.252). These findings suggest that there are differences in individuals who live in rural areas who have TB compared those who live in urban areas. TB is a challenging and time-consuming disease to treat, especially for those in rural communities, and these differences allow us to better tailor treatment and resources to meet the needs of individuals battling TB most effectively in rural and urban communities. 

 

Table of Contents

Introduction 1

Methods 4

Results 8

Discussion 19

Acknowledgements 23

References 24

Appendix 27

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Rural Tuberculosis
Committee Chair / Thesis Advisor	Castro, Kenneth, Emory University

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