Citation
Noppert, Grace A.; Yang, Zhenhua; Clarke, Philippa J.; Ye, Wen; Davidson, Peter; & Wilson, Mark L. (2017). Individual- and Neighborhood-Level Contextual Factors Are Associated with Mycobacterium tuberculosis Transmission: Genotypic Clustering of Cases in Michigan, 2004-2012. Annals of Epidemiology, 27(6), 371-6.e5. PMCID: PMC5583706Abstract
PURPOSE: Using genotyping data of Mycobacterium tuberculosis isolates from new cases reported to the tuberculosis (TB) surveillance program, we evaluated risk factors for recent TB transmission at both the individual- and neighborhood- levels among U.S.-born and foreign-born populations.METHODS: TB cases (N = 1236) reported in Michigan during 2004 to 2012 were analyzed using multivariable Poisson regression models to examine risk factors for recent transmission cross-sectionally for U.S.-born and foreign-born populations separately. Recent transmission was defined based on spoligotype and 12-locus-mycobacterial interspersed repetitive unit-variable number tandem repeat typing matches of bacteria from cases that were diagnosed within 1 year of each other. Four classes of predictor variables were examined: demographic factors, known TB risk factors, clinical characteristics, and neighborhood-level factors.
RESULTS: Overall, 22% of the foreign-born cases resulted from recent transmission. Among the foreign-born, race and being a contact of an infectious TB case were significant predictors of recent transmission. More than half (52%) of U.S.-born cases resulted from recent transmission. Among the U.S.-born, recent transmission was predicted by both individual- and neighborhood-level sociodemographic characteristics.
CONCLUSIONS: Interventions aimed at reducing TB incidence among foreign-born should focus on reducing reactivation of latent infection. However, reducing TB incidence among the U.S.-born will require decreasing transmission among socially disadvantaged groups at the individual- and neighborhood- levels. This report fills an important knowledge gap regarding the contemporary social context of TB in the United States, thereby providing a foundation for future studies of public health policies that can lead to the development of more targeted, effective TB control.
URL
http://dx.doi.org/10.1016/j.annepidem.2017.05.009Reference Type
Journal ArticleYear Published
2017Journal Title
Annals of EpidemiologyAuthor(s)
Noppert, Grace A.Yang, Zhenhua
Clarke, Philippa J.
Ye, Wen
Davidson, Peter
Wilson, Mark L.