Risk factors underlying racial and ethnic disparities in tuberculosis diagnosis and treatment outcomes, 2011-19: a multiple mediation analysis of national surveillance data.
| Autor: | Regan M; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA. Electronic address: mathildaregan@hsph.harvard.edu., Barham T; Office of Health Equity, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA., Li Y; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA., Swartwood NA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA., Beeler Asay GR; Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA., Cohen T; Yale School of Public Health, New Haven, CT, USA., Horsburgh CR Jr; Department of Epidemiology, Department of Biostatistics, and Department of Global Health, School of Public Health, Boston University, Boston, MA, USA; Department of Medicine, School of Medicine, Boston University, Boston, MA, USA., Khan A; Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA., Marks SM; Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA., Myles RL; Office of Health Equity, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA., Salomon JA; Department of Health Policy, Stanford University, Stanford, CA, USA., Self JL; Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA., Winston CA; Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA., Menzies NA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA. |
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| Jazyk: | angličtina |
| Zdroj: | The Lancet. Public health [Lancet Public Health] 2024 Aug; Vol. 9 (8), pp. e564-e572. |
| DOI: | 10.1016/S2468-2667(24)00151-8 |
| Abstrakt: | Background: Despite an overall decline in tuberculosis incidence and mortality in the USA in the past two decades, racial and ethnic disparities in tuberculosis outcomes persist. We aimed to examine the extent to which inequalities in health and neighbourhood-level social vulnerability mediate these disparities. Methods: We extracted data from the US National Tuberculosis Surveillance System on individuals with tuberculosis during 2011-19. Individuals with multidrug-resistant tuberculosis or missing data on race and ethnicity were excluded. We examined potential disparities in tuberculosis outcomes among US-born and non-US-born individuals and conducted a mediation analysis for groups with a higher risk of treatment incompletion (a summary outcome comprising diagnosis after death, treatment discontinuation, or death during treatment). We used sequential multiple mediation to evaluate eight potential mediators: three comorbid conditions (HIV, end-stage renal disease, and diabetes), homelessness, and four census tract-level measures (poverty, unemployment, insurance coverage, and racialised economic segregation [measured by Index of Concentration at the Extremes Findings: During 2011-19, 27 788 US-born individuals and 57 225 non-US-born individuals were diagnosed with active tuberculosis, of whom 27 605 and 56 253 individuals, respectively, met eligibility criteria for our analyses. We did not observe evidence of disparities in tuberculosis outcomes for non-US-born individuals by race and ethnicity. Therefore, subsequent analyses were restricted to US-born individuals. Relative to White individuals, Black and Hispanic individuals had a higher risk of not completing tuberculosis treatment (adjusted relative risk 1·27, 95% CI 1·19-1·35; 1·22, 1·11-1·33, respectively). In multiple mediator analysis, the eight measured mediators explained 67% of the disparity for Black individuals and 65% for Hispanic individuals. The biggest contributors to these disparities for Black individuals and Hispanic individuals were concomitant end-stage renal disease, concomitant HIV, census tract-level racialised economic segregation, and census tract-level poverty. Interpretation: Our findings underscore the need for initiatives to reduce disparities in tuberculosis outcomes among US-born individuals, particularly in highly racially and economically polarised neighbourhoods. Mitigating the structural and environmental factors that lead to disparities in the prevalence of comorbidities and their case management should be a priority. Funding: US Centers for Disease Control and Prevention National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention Epidemiologic and Economic Modeling Agreement. Competing Interests: Declaration of interests We declare no competing interests. (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC 4.0 license. Published by Elsevier Ltd.. All rights reserved.) |
| Databáze: | MEDLINE |
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