Date of Award

5-17-2013

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Richard Rothenberg

Second Advisor

Dr. Sheryl Strasser

Abstract

ABSTRACT

INTRODUCTION: Multi-drug resistant tuberculosis (MDR-TB) poses a great threat to the eradication of TB. In the US, MDR-TB is faced with inadequate diagnostic tools and long and expensive treatment regimens. Therefore, preventing the disease is the key to saving lives and resources. Social and behavioral variables play a big part in this prevention. It is important to determine the social factors that may lead to MDR-TB in order to set up prevention programs and more efficient treatment regimens.

AIM: This study was conducted to ascertain the social determinants of MDR-TB in the US between the years of 2005 and 2009 to better equip public health officials to deal with this growing threat.

METHODS: This study used the Centers for Disease Control and Prevention (CDC) Online Tuberculosis Information System (OTIS) database to find associations between certain social variables and MDR-TB. The variables that were tested were whether or not the individual had lived in a correctional facility for the past year; HIV status; homelessness; whether or not the individual had an occupation; and whether the individual was foreign-born or US-born. An unadjusted odds ratio (OR) was calculated to find this association. The variables were then stratified with age; sex; race; age and race; age and sex; and age, sex, and race to see whether or not the strata were confounders.

RESULTS: The variables of having lived in a correctional facility and homelessness were found to be associated with MDR-TB. However, all of the strata were found to be confounders for this relationship. Having HIV and being US-born were not found to be associated with MDR-TB. All of the strata for HIV were found to be confounders. But for place of birth, stratifying by age, sex, and both age and sex were not confounders. The rest of the strata were. The OR for occupation versus MDR-TB was almost at 1, meaning that those with a job and those without a job had almost equal odds of having MDR-TB. Effect modification was present for the strata in all variables, meaning that the risk of having MDR-TB varied with each different age, sex, and racial group.

DISCUSSION: Results from this study showed which variables were more likely to be associated with MDR-TB in the US between the years of 2005 and 2009. However, when compared to the literature that exists, the results showed that more research needs to be done to properly ascertain this relationship. Using this study, public health officials can identify which populations to focus prevention efforts on.

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