Epidemiologic study of tuberculosis in the African American Community
Royce, R. A., Katz, D., Pagaoa, M., & Wallace, C. (2011). Epidemiologic study of tuberculosis in the African American Community. In , p. A1858. .
Though U.S. rates of tuberculosis (TB) continue to decline across all racial groups, a 7 to 8-fold excess among U.S.-born African Americans
(blacks) compared to U.S.-born whites has persisted. Few epidemiologic studies have addressed this health disparity. This study
investigates timeliness of care-seeking, diagnosis, and treatment for U.S.-born black and white TB patients and its association with spread
of TB. A better understanding of the barriers to early intervention may help in development of specific strategies to speed TB control
In this multi-site study by the TB Epidemiologic Studies Consortium, eight states—Georgia, Maryland, New Jersey, New York City, North
Carolina, Virginia, Tennessee, and Texas—enrolled U.S.-born blacks and whites ages 15 and older reported with verified TB from 2009
through 2010. After consenting, study participants were interviewed, their health department records abstracted, and routinely-collected
surveillance and genotyping information obtained from state databases. Surveys of health department services and practices and census
tract information will be linked to study participants for multilevel modeling.
In preliminary analysis of the first 272 enrolled, 90.8% reported symptoms prior to diagnosis, and 71.9% gave symptoms as their reason for
seeking the care that resulted in their TB diagnoses. Individuals often attributed their symptoms to other causes such as colds or flu
(19.5%). Cases had a median of 2 health care visits before diagnosis (range, 1-33). Comparisons by race showed that blacks and whites
differed by age and gender; whites were older (pself-reported symptom onset to diagnosis was 107 with no significant difference between blacks and whites. Median number of days
elapsed from symptom onset to first doctor visit was 61 for blacks and 31 for whites (p=.10). Median number of days from first doctor visit
to diagnosis was 63.5 for blacks and 78 for whites, respectively.
To our knowledge this is the first epidemiologic study on a national scale of TB among blacks compared to whites. TB affects a wider
sociodemographic segment of blacks than it does whites. Although symptoms of TB were a common precipitating condition for seeking
care, many had attributed these symptoms to causes other than TB. Preliminary data suggests that barriers and delays in seeking care may
contribute to the TB disparity; further data collection and analysis is necessary to confirm this finding.