Date of Award

Spring 5-16-2014

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Richard Rothenberg

Second Advisor

Dr. Ike S Okosun

Abstract

Tuberculosis (TB) is a public health challenge globally. In the US, TB is unevenly distributed based on country of birth. Since 1993, TB disproportionately has been decreasing among US and foreign born persons. In 1993, the proportion of TB among foreign born persons was 30% while in 2012, 65% of TB cases were foreign born persons. US is a country with an open immigration policy which can challenge TB control by entering more immigrants with latent TB infection (LTBI). Therefore, this study is aimed to indentify the characteristics of LTBI persons, estimate the odds having LTBI among risk groups, and compare risk factors of LTBI between foreign and US born persons. In this study, a two year sample (NHANES, 2011-2012) is considered and 6,185 observations are included in the analysis. Among all LTBI (526), 21%, 46%, 31%, 7%, and 65% were diabetic, smoker, age group≥65, TB contact, and foreign born respectively. Among all risk factors, diabetes (OR=1.45, 95% CI: 1.14-1.86), smoking (OR=1.63, 95% CI: 1.33-1.86), age group ≥65 (OR=1.97, 95% CI: 1.58-2.45), TB contacts (OR=2.54, 95% CI: 1.69-3.82), and foreign born (OR=5.70, 95% CI: 4.65-7.00) were significantly associated with LTBI. The association between LTBI and foreign born is approximately six times higher than the association between US born and LTBI, indicating that TB infection exposure is very high among foreign born persons. This fact is an obstacle toward achieving TB eradication goal in the US. Thus, proper interventions such as screening and treatment of foreign born persons coming from TB endemic countries, particularly those who are in high risk groups will take TB control program one step closer to the eradication of the disease in the US.

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