Comparing treatment outcomes among US-born versus foreign-born patients diagnosed with tuberculosis in the state of Georgia, 2005-2015 Open Access

George, Nisha (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/qf85nb31g?locale=en
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Abstract

Elimination of tuberculosis (TB) in the United States necessitates early diagnosis and successful treatment of all cases and the prevention of transmission of Mycobacterium tuberculosis to new individuals. Foreign-born individuals bear a disproportionate burden of TB disease in the US, necessitating targeted efforts to minimize TB-related morbidity and mortality and prevent further transmission within this population. We investigated the association between country of birth and unfavorable treatment outcomes (i.e. prolonged or incomplete treatment) among new verified cases in the state of Georgia and sought to identify any risk factors that hinder the timely completion of treatment. We analyzed verified cases reported through the State Electronic Notifiable Disease Surveillance System (SendSS) to the Georgia Department of Public Health (GADPH) during January 2005-December 2015, who were followed through the completion of their treatment or until December 31, 2017, whichever occurred first. We used multivariable logistic regression to assess the association between TB treatment outcomes and country of origin while controlling for sociodemographic and clinical covariates available in case report forms. Of the 4,210 analyzed cases, 547 (13%) experienced unfavorable treatment outcomes, including 253 of 2,347 (11%) US-born cases and 294 of 1,860 (16%) foreign-born cases. After controlling for confounders, the odds of having an unfavorable outcome among foreign-born patients was higher when compared to their US-born counterparts [adjusted OR (aOR) = 1.34; 95% confidence interval (CI): (1.03, 1.74)]. In addition, the covariates that were significantly associated with an unfavorable TB treatment outcome include being male [aOR = 1.45; 95% CI: (1.14, 1.85)], being Hispanic [aOR = 2.13; 95% CI: (1.61, 2.82)], having positive sputum smear [aOR = 1.57; 95% CI: (1.24, 2.00)], being unemployed [aOR = 1.54; 95% CI: (1.23,  1.92)], having extrapulmonary TB disease [aOR = 1.80; 95% CI: (1.33, 2.45)], and having unknown prior history of illicit drug use [aOR = 5.47; 95% CI: (1.81, 16.50)]. Our results suggest that, in addition to clinical risk factors, various sociodemographic and environmental factors might play a role in hampering the success of TB treatment among foreign-born persons. Evidence-based interventions to target and improve treatment outcomes in foreign-born cases are needed to improve control TB in Georgia.

Table of Contents

Background and Aims…………………………………………………………..…………1

 

Methods………………………………………………………………………………...….4

 

Results……………………………………………………………………………………..9

 

Discussion………………………………………………………………………………..12

 

References……….……………………………………………………………………….20

 

Tables and Figures……………………………………………………………………….27

 

Appendix A: Model and Partial SAS Code…………………………………………..….34

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