Document Detail

Area-level socioeconomic disadvantage and severe pulmonary tuberculosis: U.S., 2000-2008.
MedLine Citation:
PMID:  23450874     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Lower socioeconomic status (SES) is associated with increased risk of tuberculosis (TB) and diagnostic delays, but the extent to which this association reflects an underlying gradient in advanced status of pulmonary TB is unknown. We conducted a multilevel retrospective cohort analysis examining the relationship between socioeconomic characteristics and pulmonary TB disease status, as measured via sputum smears and chest radiography results.
METHODS: We included 862 incident TB patients reported in King County, Washington, from 2000-2008. We abstracted patient-level measures from charts and surveillance data. We obtained socioeconomic characteristics of TB patients, as well as those of the areas where TB patients lived, from the 2000 U.S. Census. A socioeconomic position (SEP) index was derived to measure SES.
RESULTS: Of those with known results, 814 of 849 patients (96%) displayed abnormal radiography findings. A total of 239 graded patients (39%) had positive smears, 136 (57%) of whom had grades of moderate (3+) or numerous (4+) acid-fast bacilli. In unadjusted analyses, patients living in lower SEP areas did not appear to have higher probabilities of more advanced disease. In multivariate models adjusting for individual demographic and socioeconomic measures, as well as area-based demographic variables, block-group SEP was not significantly associated with more advanced pulmonary disease.
CONCLUSIONS: Lower SEP was not significantly associated with greater pulmonary disease severity after controlling for individual age, race, sex, and origin, and block-group race, ethnicity, and origin. These findings suggest that the severity of pulmonary TB at diagnosis is not synonymous with delayed diagnosis.
Eyal Oren; Masahiro Narita; Charles Nolan; Jonathan Mayer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Public health reports (Washington, D.C. : 1974)     Volume:  128     ISSN:  1468-2877     ISO Abbreviation:  Public Health Rep     Publication Date:    2013 Mar-Apr
Date Detail:
Created Date:  2013-03-01     Completed Date:  2013-04-23     Revised Date:  2014-03-06    
Medline Journal Info:
Nlm Unique ID:  9716844     Medline TA:  Public Health Rep     Country:  United States    
Other Details:
Languages:  eng     Pagination:  99-109     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Child, Preschool
Cohort Studies
Delayed Diagnosis / statistics & numerical data*
Infant, Newborn
Middle Aged
Retrospective Studies
Social Class
Tuberculosis, Pulmonary / diagnosis*,  economics,  epidemiology*
Vulnerable Populations / statistics & numerical data*
Washington / epidemiology
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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