Transcript The Effect of Tuberculosis on the Asian American Population

Tuberculosis and the Asian
Population of Tarrant County, TX
By: Jessica McCallister
Definition of Foreign-Born by CDC

“A U.S.-born person was defined as
someone born in the United States or its
associated jurisdictions or someone born in a
foreign country but having at least one U.S.born parent. Persons not meeting this
definition were classified as foreign-born.”
(CDC, 2008)
Problem

According to the CDC’s National TB
Surveillance System, “progress (in TB
elimination) has slowed in recent years; the
average annual percentage decline in the TB
rate decreased from 7.3% per year during
1993-2000 to 3.8% during 2000-2008.”
(CDC, 2008)
Research Question



Is tuberculosis more prevalent in groups that
have a high percentage of foreign-born
persons?
How severe is tuberculosis prevalence
among Asians in the US?
What factors drive tuberculosis transmission
among Asians in Tarrant County?
Literature Review

Tuberculosis (TB) in native-born Americans has declined from
1993-2007, but foreign-born persons and racial/ethnic minority
populations continue to be affected disproportionately (CDC,
2008).


In the United States alone, the percentage of Asians with
tuberculosis has risen from 20 to 26 percent from 1998 to 2007
(CDC 2007).
Traditional programs targeting high-risk populations usually
exclude Asians (with high rates of TB) and threaten the
progress toward TB elimination in the US (CDC, 2008).
Rate of native-born cases vs. foreignborn cases (CDC, 2008)
Tuberculosis by State (CDC, 2008)
-Texas was one of four
states reported by the
CDC to have more
than 500 cases in
2008. (CDC, 2008)
- “These four states
accounted for
approximately half of
all TB cases in 2008.”
(CDC, 2008)
Tuberculosis Cases in Texas
Research Question


Are traditional high-risk behaviors (i.e.
alcohol abuse, drug use, homelessness,
sexual behavior, etc.) responsible for high
rates of tuberculosis in Asians?
How does the Asian population’s
participation in risky behaviors compare to
other race/ethnic groups?
Methodology


Data from tuberculosisscreening program in Tarrant
County, Texas, 1993-2006.
Using contingency tables
analysis with chi-square test of
significance studying:
Drug User- Crosstab
– Homelessness
No
Yes
– Incarceration
– Drug use
Non-Asian
464
210
– Sexual behavior
Asian
146
2
– Alcoholism, etc.
Total
610
212
Total
674
148
822
Results


Asians comprise 4.2% of the population but
contributed 18% of TB cases.
Whites are 56% of the population and
reported 26% of total cases.
Results continued..

Asians are less likely to participate in highrisk behaviors compared to other
ethnic/minority groups:
–
–
–
–
drug use (Χ2=57.426, p=.000)
alcoholism (Χ2=39.776, p=.000)
homelessness (Χ2=37.029, p=.000)
previous incarceration (Χ2=27.359, p=.000)
Research Question


Since Asian Americans have been proven
not to participate in the normal high-risk
behaviors usually associated with TB, what is
their mode of transmission?
What needs to be done in order to help
decrease the rates of TB in the Asian
American culture?
Conclusion



Most Asians acquire TB in their home countries before
entering US. About 96% of Asian TB cases in Tarrant
County were foreign-born.
Majority do not participate in the traditional high-risk
behaviors usually associated with TB.
Specific target-programs are needed to control TB in the
Asian community in order to facilitate TB elimination in
the United States.
Programs in Tarrant County,
Texas


Tarrant County offers TB skin tests, chest xrays, medications, refills, and doctor visits for
low costs to county residents (TCPH, 2009).
There was no mention of screening
programs that targeted specific members of
the community.
What needs to be done?

Specific target-programs are needed to
control TB in the Asian community in order to
facilitate TB elimination in the United States.
References





CDC Statistics. 2007. Tuberculosis cases, percentages, and case rates per
100,000 population by race only: United States, 1993-2007.
http://www.cdc.gov/tb/surv/2007/pdf/table3.pdf. Accessed 10 October
2008.
CDC Statistics. 2008. MMWR: Trends in Tuberculosis—United States,
2007. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm
Moonan, Patrick K, Manuel Bayona, Teresa N Quitugua, Joseph Oppong,
Denise Dunbar, Kenneth C Jost Jr, Gerry Burgess, Karan P Singh, and
Stephen E Weis. 2004. Using GIS technology to identify areas of
tuberculosis transmission and incidence. International Journal of Health
Geographics 3:23.
Tarrant County Public Health. Client Services: Tuberculosis, 2009.
http://www.tarrantcounty.com/ehealth/cwp/view.asp?A=763&Q=4
30433
Texas Department of State Health. Tuberculosis Statistics: 2006 TB Cases in
Texas map. www.dshs.state.tx.us/idcu/disease/tb/statistics/
Acknowledgements

I would like to thank the
following:
-
-
Dr. Joseph Oppong
Dr. Susan Eve
Dr. Gloria Cox and the
Honors College
Questions?