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Free Content Racial disparities in primary and reactivation tuberculosis in a rural community in the southeastern United States

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SETTING: A rural section of a county in central Florida.

BACKGROUND: Racial disparities in tuberculosis disease (TB) are substantial in the United States.

OBJECTIVE: To determine if TB was attributable to primary infection, reactivation or both.

DESIGN: A population-based survey of latent tuberculosis infection (LTBI), a case-control analysis of TB, and a cluster analysis of TB isolates were performed between 1997 and 2001.

RESULTS: Of 447 survey participants, 135 (30%) had LTBI. Black race was strongly associated with LTBI among US-born (OR 2.6, 95%CI 1.3–5.5) and foreign-born subjects (OR 4.3, 95%CI 2.2–8.4). Risk factors for TB included human immunodeficiency virus (HIV; OR 27.4, 95%CI 10.1–74.1), drug use (OR 4.6, 95%CI 1.7–12.4) and Black race (OR 3.4, 95%CI 1.2–9.6). The population risk of TB attributable to Black race was 64%, while that attributable to HIV was 46%. Cluster analysis showed 67% of TB cases were clustered, but Blacks were not at a significantly increased risk of having a clustered isolate (OR 2.1, 95%CI 0.12–36.0).

CONCLUSION: Both reactivation TB and recent TB transmission were increased among Blacks in this community. Therefore, LTBI screening and intensive contact tracing, both followed by LTBI treatment, will be needed to reduce TB in Blacks.
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Keywords: Black race; HIV infection; Mycobacterium tuberculosis; southeastern United States; tuberculin test; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Boston University School of Medicine, Boston, Massachusetts, USA 2: Glades Health Initiative Inc, Belle Glade, Florida, USA 3: Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA 4: Centers for Disease Control and Prevention, Atlanta, Georgia, USA 5: C L Brumback Health Center, Belle Glade, Florida, USA 6: Department of Public Health, Seattle and King County, Seattle, Washington, USA; and University of Washington School of Medicine, Seattle, Washington, USA 7: Florida Department of Health Laboratory, Jacksonville, Florida, USA 8: Science Applications International Corporation, Atlanta, Georgia, USA 9: Boston University School of Medicine, Boston, Massachusetts, USA; Boston University School of Public Health, Boston, Massachusetts, USA

Publication date: 2010-06-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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