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Tuberculosis in indigenous peoples in the U.S., 2003-2008

TitleTuberculosis in indigenous peoples in the U.S., 2003-2008
Publication TypeJournal Article
Year of Publication2011
AuthorsBloss, E, Holtz, TH, Jereb, J, Redd, JT, Podewils, LJ, Cheek, JE, McCray, E
JournalPublic Health RepPublic Health Rep
Date PublishedSep-Oct
ISBN Number0033-3549 (Print)<br/>0033-3549 (Linking)
Accession Number21886328
KeywordsAdolescent, Adult, Aged, Alaska/epidemiology/ethnology, Antitubercular Agents/therapeutic use, Child, Child, Preschool, Female, Hawaii/epidemiology/ethnology, Health Status Indicators, Humans, Indians, North American/statistics & numerical data, Inuits/statistics & numerical data, Male, Middle Aged, Oceanic Ancestry Group/statistics & numerical data, Population Surveillance, Risk Factors, Treatment Outcome, Tuberculosis/drug therapy/epidemiology/ ethnology, United States/epidemiology
AbstractOBJECTIVES: We examined trends and epidemiology of tuberculosis (TB) across racial/ethnic groups to better understand TB disparities in the United States, with particular focus on American Indians/Alaska Natives (AI/ANs) and Native Hawaiians/other Pacific Islanders (NH/PIs). METHODS: We analyzed cases in the U.S. National Tuberculosis Surveillance System and calculated TB case rates among all racial/ethnic groups from 2003 to 2008. Socioeconomic and health indicators for counties in which TB cases were reported came from the Health Resources and Services Administration Area Resource File. RESULTS: Among the 82,836 TB cases, 914 (1.1%) were in AI/ANs and 362 (0.4%) were in NH/PIs. In 2008, TB case rates for AI/ANs and NH/PIs were 5.9 and 14.7 per 100,000 population, respectively, rates that were more than five and 13 times greater than for non-Hispanic white people (1.1 per 100,000 population). From 2003 to 2008, AI/ANs had the largest percentage decline in TB case rates (-27.4%) for any racial/ethnic group, but NH/PIs had the smallest percentage decline (-3.5%). AI/ANs were more likely than other racial/ethnic groups to be homeless, excessively use alcohol, receive totally directly observed therapy, and come from counties with a greater proportion of people living in poverty and without health insurance. A greater proportion of NH/PIs had extrapulmonary disease and came from counties with a higher proportion of people with a high school diploma. CONCLUSIONS: There is a need to develop flexible TB-control strategies that address the social determinants of health and that are tailored to the specific needs of AI/ANs and NH/PIs in the U.S.
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