Changing the Paradigm: Using an Integrative Approach to Improve Understanding of Tuberculosis Control in Michigan.

[摘要] Background. In the U.S., tuberculosis (TB) continues to disproportionately affect the poor, racial/ethnic minorities, and urban dwellers, yet traditional methods of TB control focus primarily on biomedical predictors for treatment and less on social factors that could direct prevention. Although characteristics of the social and physical environment increase vulnerability to TB, declining concern over those with disease and diminished resources have stunted understanding of risk and reduced the ability to respond. Methods. Using TB case surveillance data combined with genotypic testing of samples from the Michigan Department of Health and Human Service and a novel socio-demographic survey, this dissertation takes an integrative approach to understanding the patterns of TB incidence and transmission.Research has involved: 1. Analyzing risk factors for TB incidence in Michigan; 2. Evaluating which risk factors both at the individual- and neighborhood levels were associated with pathogen genotypic and temporal clustering; and 3. Analyzing social characteristics of TB cases diagnosed in Metro Detroit to better understand how social vulnerability and behavioral contacts augment risk.Results. From 2004 through 2012, the incidence of TB throughout Michigan declined by an average of 8% per year. However, significant disparities in the average incidence rate were observed by race and nativity. Overall, 22% of the foreign-born cases of TB were estimated to be resulting from recent transmission of TB compared to 52% of the U.S.-born cases. For the U.S.-born, recent transmission was predicted more by individual-level and neighborhood-level socio-demographic factors than by clinical risk factors.Preliminary results from the socio-demographic survey suggest that while individuals with TB in Metro Detroit may be employed and have access to stable housing, they still experience significant financial strain.Conclusions: The results of this dissertation highlight some of the ways in which TB incidence is socially patterned. Interventions aimed at reducing the incidence of TB in the foreign-born population should focus on reducing reactivation of latent TB infections.However, reducing the incidence of TB among the U.S.-born will require strategies that can reduce transmission of TB among socially disadvantaged groups, both at the individual- and neighborhood-level.

[发布机构] University of Michigan

[效力级别] Public Health

[关键词] social patterning of tuberculosis;Public Health;Population and Demography;Health Sciences;Science;Social Sciences;Epidemiological Science