Racial and ethnic disparities in diagnosis and treatment outcomes among US-born people diagnosed with tuberculosis, 2003–19: an analysis of national surveillance data

Details

• Alternative Title:
  Lancet Public Health
• Personal Author:
  Regan, Mathilda ; Li, Yunfei ; Swartwood, Nicole A ; Barham, Terrika ; Beeler Asay, Garrett R ; Cohen, Ted ; Hill, Andrew N ; Horsburgh, C Robert ; Khan, Awal ; Marks, Suzanne M ; Myles, Ranell L ; Salomon, Joshua A ; Self, Julie L ; Menzies, Nicolas A
• Description:
  Background
  
  Persistent racial and ethnic disparities in tuberculosis incidence exist in the USA, however, less is known about disparities along the tuberculosis continuum of care. This study aimed to describe how race and ethnicity are associated with tuberculosis diagnosis and treatment outcomes.
  
  Methods
  
  In this analysis of national surveillance data, we extracted data from the US National Tuberculosis Surveillance System on US-born patients with tuberculosis during 2003–19. To estimate the association between race and ethnicity and tuberculosis diagnosis (diagnosis after death, cavitation, and sputum smear positivity) and treatment outcomes (treatment for more than 12 months, treatment discontinuation, and death during treatment), we fitted log-binomial regression models adjusting for calendar year, sex, age category, and regional division. Race and ethnicity were defined based on US Census Bureau classification as White, Black, Hispanic, Asian, American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and people of other ethnicities. We quantified racial and ethnic disparities as adjusted relative risks (aRRs) using non-Hispanic White people as the reference group. We also calculated the Index of Disparity as a summary measure that quantifies the dispersion in a given outcome across all racial and ethnic groups, relative to the population mean. We estimated time trends in each outcome to evaluate whether disparities were closing or widening.
  
  Findings
  
  From 2003 to 2019, there were 72 809 US-born individuals diagnosed with tuberculosis disease of whom 72 369 (35·7% women and 64·3% men) could be included in analyses. We observed an overall higher risk of any adverse outcome (defined as diagnosis after death, treatment discontinuation, or death during treatment) for non-Hispanic Black people (aRR 1·27, 95% CI 1·22–1·32), Hispanic people (1·20, 1·14–1·27), and American Indian or Alaska Native people (1·24, 1·12–1·37), relative to non-Hispanic White people. The Index of Disparity for this summary outcome remained unchanged over the study period.
  
  Interpretation
  
  This study, based on national surveillance data, indicates racial and ethnic disparaties among US-born tuberculosis patients along the tuberculosis continuum of care. Initiatives are needed to reduce diagnostic delays and improve treatment outcomes for US-born racially marginalised people in the USA.
  
  Funding
  
  US Centers for Disease Control and Prevention.
  
  
• Subjects:
  Ethnicity Female Healthcare Disparities Humans Male Racial Groups Treatment Outcome Tuberculosis United States
• Source:
  Lancet Public Health. 9(1):e47-e56
• Pubmed ID:
  38176842
• Pubmed Central ID:
  PMC11665086
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; R01 AI146555/AI/NIAID NIH HHSUnited States/ ; R01 DK090435/DK/NIDDK NIH HHSUnited States/
• Volume:
  9
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:9c499cc8b319fe673aff656ef9e5dc41b1e156ba179270488c96cbb9cb985e96c42275a835d2e29d5e686d58d8097cf1d7e5ee4d24fbd77f9ab2a4e3a9999184
• Download URL:
  https://stacks.cdc.gov/view/cdc/175244/cdc_175244_DS1.pdf
• File Type:
  [PDF - 619.21 KB ]