A county-level, ecologic analysis of correlations between recent tuberculosis transmission and socioeconomic indicators of poverty. Open Access

Abstract

We sought to determine if recent transmission (RT) of tuberculosis (TB) was associated with socioeconomic or other ecologic factors. Identification of area-level factors associated with RT of TB disease could help better predict geographic areas at risk for TB outbreaks and allow investigators to better understand TB transmission. Ecologic analyses involving TB transmission have rarely been published in the past due to the difficulty of estimating RT. We used the plausible source-case method developed by France et al which integrates genetic, geographic, and epidemiologic data to determine if a case has a plausible source case. Data was pulled from the American Community Survey (ACS) tables as well as from the National Tuberculosis Surveillance System (NTSS) and logistic modeling was used to evaluate associations. Using this measure of RT, we found associations between poverty, black race, Hispanic ethnicity, and crowding. This study is the first study, to date, to use the plausible source-case method as a measure of RT to evaluate county-level factors and their association with estimated RT. Pediatric cases were underrepresented in this study as a consequence of the criteria within the plausible source case method and further research is needed to evaluate if inclusion of pediatric cases would change these associations. Further study using multilevel models that integrate area-level and patient-level characteristics would allow for even greater understanding of the associations between SES, demographics, and risk factors for RT of TB. Data sources for this study are regularly produced/updated and readily available for research which leads to this study being easy to repeat or modify in order to continual evaluate the associations between SES and RT at the county level.

Table of Contents

Table of Contents

Chapter 1: Background.................................................................................................................... 2

Chapter 2....................................................................................................................................... 12

Introduction.................................................................................................................................. 12

Methods....................................................................................................................................... 14

Results......................................................................................................................................... 19

Discussion.................................................................................................................................... 21

Chapter 3:...................................................................................................................................... 27

Summary..................................................................................................................................... 27

Public Health Implications............................................................................................................ 27

Possible Future Directions............................................................................................................. 29

Tables and Figures......................................................................................................................... 30

Figure 1: Plausible Source-Case Method Flow Chart....................................................................... 30

Table 1: County-level census measures from 1-year estimates......................................................... 31

Table 2: County-level census measures from 5-year estimates......................................................... 32

Table 3: Data sources and variable names...................................................................................... 33

Table 4: County-level census measures associations....................................................................... 34

References...................................................................................................................................... 35

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Ecologic Transmission Tuberculosis Recent Transmission
Committee Chair / Thesis Advisor	Yan Sun, Emory University Benjamin Silk, Centers for Disease Control and Prevention

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