Email updates

Keep up to date with the latest news and content from BMC Infectious Diseases and BioMed Central.

Open Access Highly Accessed Research article

Neighborhood socioeconomic position and tuberculosis transmission: a retrospective cohort study

Eyal Oren12*, Masahiro Narita34, Charles Nolan2 and Jonathan Mayer2

Author Affiliations

1 Division of Epidemiology & Biostatistics, University of Arizona, Tucson, AZ, USA

2 Department of Epidemiology, University of Washington, Seattle, WA, USA

3 Public Health-Seattle & King County Tuberculosis Control Program, Seattle, WA, USA

4 Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA

For all author emails, please log on.

BMC Infectious Diseases 2014, 14:227  doi:10.1186/1471-2334-14-227

Published: 27 April 2014

Abstract

Background

Current understanding of tuberculosis (TB) genotype clustering in the US is based on individual risk factors. This study sought to identify whether area-based socioeconomic status (SES) was associated with genotypic clustering among culture-confirmed TB cases.

Methods

A retrospective cohort analysis was performed on data collected on persons with incident TB in King County, Washington, 2004–2008. Multilevel models were used to identify the relationship between area-level SES at the block group level and clustering utilizing a socioeconomic position index (SEP).

Results

Of 519 patients with a known genotyping result and block group, 212 (41%) of isolates clustered genotypically. Analyses suggested an association between lower area-based SES and increased recent TB transmission, particularly among US-born populations. Models in which community characteristics were measured at the block group level demonstrated that lower area-based SEP was positively associated with genotypic clustering after controlling for individual covariates. However, the trend in higher clustering odds with lower SEP index quartile diminished when additional block-group covariates.

Conclusions

Results stress the need for TB control interventions that take area-based measures into account, with particular focus on poor neighborhoods. Interventions based on area-based characteristics, such as improving case finding strategies, utilizing location-based screening and addressing social inequalities, could reduce recent rates of transmission.

Keywords:
Tuberculosis; Genotyping; Socioeconomic status; Infectious disease transmission; Multilevel; Molecular epidemiology