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... aged 20 to 45 years. Age adjustment was accounted for using the direct method with 1990 U. S.
population statistics as follows: aged 15 - 24 (80, 596, 000); aged 45 - 46 (46, 710, 000) (Tuberculosis control law 1993). iii. data analysis and results 1860 cases were explored in both South Central and Harlem. Both districts are low-income, medically under-served communities with large numbers of immigrants such as Hispanics, blacks or Asian-Pacific Islanders. The data was evaluated with the objective of describing the incidence of TB of various racial-ethnic groups from the low-income areas mentioned above, over a five-year period. The incidence of tuberculosis was highest among those aged 25 - 44 in both areas, with South Central at 40. 5 % and Harlem at 40 %.
The majority of cases in both areas were also comprised of immigrants. More than 60 % of cases in South Central were among immigrants, and 95 % of these were either Asian Pacific Islanders or Hispanics. The Asian Pacific Islanders consistently rated with the highest incidence of TB in South Central over the five year period, followed by Hispanics. Incidence of TB among Asians averaged approximately 4 times greater than the rate for New York as a whole. In Harlem, non-Hispanic blacks and Hispanics constituted the largest number of cases. In both areas, non-Hispanic whites had the lowest rates of TB throughout the five years in question.
Comparisons with other non-Hispanic, non-Asian whites clearly demonstrate that ethnic minorities show an excess of TB morbidity. People co-infected with HIV more than doubled during the five year period from 1989 to 1993. For instance, there were 25 cases reported in 1989, which rose to 54 by 1993 in these districts taken together. 200 HIVTB cases were reported during the five year interval, of which 180 of 200 were male, and 152 of 200 were between the ages of 25 - 44. Of these, Hispanics comprised the largest proportion at 42. 4 %, followed by non-Hispanic Whites (36. 7 %), non-Hispanic blacks followed at 17. 1 %, and finally Asians at 4. 0 %. There is a clear overlap of the incidence of TB and HIV with the cases used in this study.
In other areas, the economically disadvantaged living in medically under-served communities tend also to be undernourished, unemployed and sometimes homeless. In the two areas in question in this study, there is also an increased risk of re-infection with TB not only for those co-infected with HIV, but for others whose living conditions and access to medical care (and surveillance during treatment to ensure that the course of medication is carried out) is poor. Discussion / conclusion Both South Central and Harlem are populated metropolitan areas with a rapid influx of immigrants who keep the population fluid and ethnically diverse. On a national level, the ethnic breakdown of the 3 million U.
S. residents were classified as follows in 1993, the last year of this study: 65 % were classified as non-Hispanic whites; 20 % as Hispanic; 7 % as Asian Pacific Islanders; and 6 % as non-Hispanic blacks (Baerji et al. 1996). Again, on a national scale, these statistics relate to verified TB cases as follows: 42. 4 % of patients were Hispanic; 28. 8 %, Asian Pacific Islanders; 10. 1 % were non-Hispanic blacks; and 18. 4 % were non-Hispanic whites (Baerji et al. 1996). To add more recent statistics to these figures, 98 % of the 2 million annual global deaths from TB, and as much as 95 % of the new active cases (numbering 8 million), are recorded in developing countries such as India, Nepal, Uganda and Cambodia, or in the former Soviet Republics (Capdevila 2000). More specific to the U. S. , the Atlanta-based Center for Disease Control and Prevention reported that foreign-born people comprised 41 % of the 18, 361 cases of TB reported in America in 1998 (Capdevila 2000).
In 1999, 43 of the reported 17, 500 cases were among the foreign-born (Okie 2000). Consider that in 1992, the figure was 27 % (Okie 2000). Even more alarmingly, the World Health Organization reports that there are between 10 and 15 million people in the U. S. who have latent tuberculosis (Capdevila 2000). It is evident from these results that the incidence of TB is higher in ethnic groups, particularly among males between the ages of 25 and 44.
This might be due to factors such as working conditions, nutrition, drug and alcohol abuse and HIV infection. Therefore, returning to the hypothesis, this study suggests that the incidence of tuberculosis is indeed higher among low-income people because they are less likely to seek medical care. But to say so it only to begin, not to conclude the search for answers regarding TB in people of this background. The objective of this study has been to suggest that the risk of TB itself is higher in low-income areas, which also tend to be medically under-served. In this sense, this study supports Alan Bloch et al. s (1996) findings, these being that given the recent changes in the epidemiology of TB in the U.
S. , public health officials nationwide must consider expanded surveillance variables, such as co-infection with HIV. The nature of low-income communities must also be further investigated with regard to TB and cases of infection and re-infection. Ethnic minorities, who make up the bulk of TB cases are less likely to seek medical care. More work needs to be done on why this is the case. Is it because that medical care simply is not available or easily accessible?
Or is it too costly, poorly monitored in terms of carrying treatment to its conclusion, or are there other cultural or language barriers that remain to be determined? Considering the high rate of ethnic racial incidence of TB, the cultural question is something that must be further investigated. More work also needs to be done on the regional variations of the incidence of TB. Baerji et al. (1996) suggest that the proportion of cases is almost double in the San Diego area than in other Southern States such as Texas and Florida. Immigrants and refugees from Mexico, the Philippines, Vietnam and Cambodia have contributed heavily to the incidence of TB in San Diego (Baerji et al. 1996).
This study suggests that the high incidence of immigrants in South Central and the racial make-up of Harlem may have a similar pattern. The U. S. government has made an effort to adjust immigration procedures to better screen those infected with TB.
Still, many with latent tuberculosis manage to enter the country, and settling in low income areas like those in question in this study, help to make up the tens of thousands of new cases each year. If we are to optimize the clinical management of TB in the U. S. as a whole, it is critical to have a better understanding of several factors.
For one, how the disease is expanding globally. How is it passing into the U. S. , and in what local regions it tends to flourish and why? As the hypothesis of this paper suggests, the areas in which immigrants who are most likely to bring TB infection into the country tend to settle in districts where the disease is difficult not only to diagnose, but also to cure and to prevent in the future. The complexity of the problem is magnified in areas like that of South Central and Harlem because they are medically under-served. Disease control and surveillance is far more difficult to observe and act on when there are numerous cases of undocumented people, thus making numbers unquantifiable.
To conclude, while race and income level are almost certainly contributors to the incidence of TB in these and other areas in the U. S. , the likeliness of seeking medical care is only one of the problems that need to be targeted. More culturally sensitive strategies are needed to more aggressively manage, survey and prevent TB in low-income areas in which immigrants tend to settle. Works Cited Andersson, N. (1990). Tuberculosis and social stratification in South Africa, International Journal of Health Services (Vol. 20, No. 1), pp. 141 - 165. Baerji, Subroto, Amy Bellamy, Elena Yu, Stephen Waterman, Elizabeth Haas, Kathleen Moser. (1996).
Tuberculosis in San Diego County: a border community perspective, Public Health Reports. Bloch, Alan, Ida Onorato, Walter Il, James Harlem, H. , Christopher, Dixie Snider Jr. (1996). The need for epidemic intelligence, Public Health Reports (tuberculosis). Bloch, A. , H. L. Reader, G.
D. Kelly, G. M. Caution, C.
H. Hayden, D. E. Snider (1989).
The Epidemiology of Tuberculosis in the United States, Sem Respir Infect (Vol. 4), pp. 157 - 170. Capdevila, Ines (03. 22. 2000). Morella, Brown sponsor bill to curb tuberculosis abroad, The Washington Times. Lesson, A. R. , L. L.
Hilton, A. M. Johnston, C. R. Hayman, C. A.
Miller and S. E. Valley (1999). Tuberculin skin testing among economically disadvantaged youth in a federally-funded job training program, American Journal of Epidemiology (Vol. 149, No. 11, April 1), pp. 671 - 679. National Center for Health Statistics. (1993).
Health, United States, Washington D. C. : Government Printing Office, 1994. DHHS Pub. No. (PHS) 94 - 1232. (Cited in Subroto Baerji et al. 1996). Okie, Susan. (05. 05. 2000). TB tests of Immigrants Urged; Panel Offers Blueprint to Eliminate the Disease in U.
S. , The Washington Post. Tuberculosis control law United States. (1993). Recommendations of the Advisory Council for the Elimination of Tuberculosis (ACET). MMWR, Morbid Mortal Wkly Rep. 1993: 42 (RR- 15): 1 - 28. (Cited in Subroto Baerji et al. 1996).
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Research essay sample on The Of Tuberculosis Among Low Income People
