health disparities in tuberculosis among asians as compared to … · 2015-10-30 · tuberculosis:...

Tuberculosis: a Health Disparity Among Asians in Massachusetts as Compared

to the General Population BY SARAH NZIKOBA, STEPHANIE TRAN, PHUNG VUONG

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WHAT IS TUBERCULOSIS (TB)?

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http://www.medindia.net/patients/patientinfo/images/tuberculosis-tb.jpg http://cdn2b.examiner.com/sites/default/files/styles/image_content_width/hash/9d/d9/1361201913_5934_tb.jpg?itok=wFURy6-q

AN AIRBORNE NIGHTMARE

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http://www.lloydhealthcare.org/wp-content/uploads/2015/03/Tuberculosis-symptoms.png

WHAT IS A HEALTH DISPARITY?

“The difference in the

incidence, prevalence,

mortality, and burden of

disease and other adverse

health conditions that exist

among specific population

groups in the United States.”

(National Institutes of Health)

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http://indivision.ca/imageland//3353.jpg

RISK FACTORS

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7 Massachusetts Department of Public Health

*Total percentage is higher than 100%; some categories overlapped

TB DISPARITY IN ASIANS

8 Massachusetts Department of Public Health

9 Massachusetts Department of Public Health

10 Massachusetts Department of Public Health

11 Boston Public Health Commission

12 Boston Public Health Commission

13 Boston Public Health Commission

IMMIGRATION

• Immigration is a social

determinant of health

• Issues with the immigration

process

• Key issues at destination:

• Overcrowded working and

living conditions

• Language and cultural

barriers

• Lack of healthcare access

14 http://organizations.bloomu.edu/douglass/Images/GlobeHands.jpg

GENETIC FACTORS

• IL-18 gene o Activates macrophages - helps kill MTB

o Polymorphisms alter IL-18 expression via binding of transcription factors

• P2X7 receptor gene 1513 A→C polymorphism o P2X7 receptor - induced by ATP to engulf and clear MTB in macrophages

o 1513 A→C SNP reduces P2X7 function

15 http://www.genecards.org/pics/loc/IL18-gene.png

WAYS TO COUNTER TB HEALTH DISPARITIES

1. Facilitate patient awareness and education for prevention,

diagnosis, and treatment of tuberculosis

2. Create or modify local, low-cost TB screening programs in at-

risk cities

3. Improve screening processes during immigration

4. Embrace diverse cultures and provide support services

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CONCLUSION

• Highest number of TB cases in MA found in Asians (44%)

• Boston has about 5 times as many cases as other major cities

• Foreign-born cases make up 80-90% of all TB cases in Boston

• Immigration plays an important role in TB disparity

• Potential genetic factors affect TB susceptibility in Asians

• Plan to reduce TB Health Disparities

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REFERENCES "Controlling Tuberculosis in the United States." Centers for Disease Control and Prevention. Centers for Disease Control and

Prevention, 4 Nov. 2005. Web. 11 June 2015.

"How The Body Reacts To Tuberculosis." YouTube. Medecins Sans Frontieres, 20 Mar. 2014. Web. 11 June 2015.

Magee, Elvin, MPH, and Gail Grant. "Tuberculosis - United States, 1993-2010." By Awal D. Khan. Vol. 62. Suppl 3. 149-54. CDC

Health Disparities and Inequalities Report--United States,

2013. Centers for Disease Control and Prevention, 22 Nov. 2013. Web. 11 June 2015.

Mandal, Ananya, MD. "History of Tuberculosis." News-Medical.net. N.p., 3 Feb. 2014. Web. 11 June 2015.

"Migration & Tuberculosis: A Pressing Issue." International Organization for Migration.Web.

Narasimhan, Padmanesan, James Wood, Chandini Raina MacIntyre, and Dilip Mathai. "Risk Factors for Tuberculosis." Hindawi

Publishing Corporation. Hindawi Publishing Corporation, 5 Jan. 2013. Web. 11 June 2015.

"Summary Tuberculosis Statistics for the Year 2011." Massachusetts Department of Public Health.Web.

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REFERENCES "Summary Tuberculosis Statistics for the Year 2012." Massachusetts Department of Public

"Summary Tuberculosis Statistics for the Year 2013." Massachusetts Department of Public

"Summary Tuberculosis Statistics for the Year 2014." Massachusetts Department of Public

"Tuberculosis Impact in Boston Residents: 2011." Boston Public Health Commission.Web.

"Tuberculosis Impact in Boston Residents: 2014." Boston Public Health Commission.Web.

Wu, Guannan, et al. "The Effect of P2X7 Receptor 1513 Polymorphism on Susceptibility to Tuberculosis: A Meta-Analysis."

Infection, Genetics and Evolution 24.0 (2014): 82-91. Print.

Wu, Jie, and Koustuv Dalal. "Tuberculosis in Asia and the Pacific: The Role of Socioeconomic Status and Health System

Development." International Journal of Preventive Medicine. Medknow Publications & Media Pvt Ltd, Jan. 2012. Web. 11

June 2015.

Yu, Xiao-Ling, et al. "IL-18 Genetic Polymorphisms may Contribute to the Pathogenesis of Tuberculosis among Asians: A Meta-

Analysis of Case-Control Studies." 41 (2014): 6013-6023. Web.

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ANY QUESTIONS?

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