Contextualizing Tuberculosis Risk in Time and Space: Comparing Time-Restricted Genotypic Case Clusters and Geospatial Clusters to Evaluate the Relative Contribution of Recent Transmission to Incidence of TB Using Nine Years of Case Data from Michigan, USA

Citation

Noppert, Grace A.; Yang, Zhenhua; Clarke, Philippa J.; Davidson, Peter; Ye, Wen; & Wilson, Mark L. (2019). Contextualizing Tuberculosis Risk in Time and Space: Comparing Time-Restricted Genotypic Case Clusters and Geospatial Clusters to Evaluate the Relative Contribution of Recent Transmission to Incidence of TB Using Nine Years of Case Data from Michigan, USA. Annals of Epidemiology, 40, 21-7.e3. PMCID: PMC6996495

Abstract

PURPOSE: Novel approaches must address the underlying factors sustaining the tuberculosis (TB) epidemic in the United States, specifically what maintains new Mycobacterium tuberculosis (Mtb) transmission.
METHODS: Culture-confirmed TB cases reported to the Michigan Department of Health and Human Services (2004-2012) were analyzed for time-restricted genotypic and/or geospatial clustering. Cases with both types of clustering were used as a proxy for recent, local transmission. Modified, multivariate Poisson regression models were fit to estimate this prevalence in relation to various individual- and neighborhood-level demographic and socio-economic variables.
RESULTS: Those individuals that were spatially clustered were 1.7 times as likely to also be time-restricted genotypically clustered. The prevalence of recent, local transmission was higher among U.S.-born cases, males, and non-Hispanic blacks. Moreover, people living in neighborhoods in the highest poverty quartile had 13.8 times the prevalence of recent, local transmission compared with those in the lowest poverty neighborhoods.
CONCLUSIONS: Our results suggest geographic areas with high concentration of TB cases are likely driven by ongoing transmission, rather than enclaves of individuals who have reactivated a case of latent TB. Furthermore, efforts to continue reducing Mtb transmission in the United States, and other low-incidence settings, must better identify community-level sources of risk, manifested through the complex social interactions among people and their environments.

URL

http://dx.doi.org/10.1016/j.annepidem.2019.10.001

Reference Type

Journal Article

Year Published

2019

Journal Title

Annals of Epidemiology

Author(s)

Noppert, Grace A.
Yang, Zhenhua
Clarke, Philippa J.
Davidson, Peter
Ye, Wen
Wilson, Mark L.

PMCID

PMC6996495

ORCiD

Noppert - 0000-0002-2040-960x