title: Tuberculosis in indigenous peoples in the U.S., 2003-2008.
abstract: OBJECTIVE
  We examined trends and epidemiology of tuberculosis (TB) across racial/ethnic groups to better understand TB disparities in the United States, with particular focus on American Indians/Alaska Natives (AI/ANs) and Native Hawaiians/other Pacific Islanders (NH/PIs).
  
  
  METHODS
  We analyzed cases in the U.S. National Tuberculosis Surveillance System and calculated TB case rates among all racial/ethnic groups from 2003 to 2008. Socioeconomic and health indicators for counties in which TB cases were reported came from the Health Resources and Services Administration Area Resource File.
  
  
  RESULTS
  Among the 82,836 TB cases, 914 (1.1%) were in AI/ANs and 362 (0.4%) were in NH/PIs. In 2008, TB case rates for AI/ANs and NH/PIs were 5.9 and 14.7 per 100,000 population, respectively, rates that were more than five and 13 times greater than for non-Hispanic white people (1.1 per 100,000 population). From 2003 to 2008, AI/ANs had the largest percentage decline in TB case rates (-27.4%) for any racial/ethnic group, but NH/PIs had the smallest percentage decline (-3.5%). AI/ANs were more likely than other racial/ethnic groups to be homeless, excessively use alcohol, receive totally directly observed therapy, and come from counties with a greater proportion of people living in poverty and without health insurance. A greater proportion of NH/PIs had extrapulmonary disease and came from counties with a higher proportion of people with a high school diploma.
  
  
  CONCLUSIONS
  There is a need to develop flexible TB-control strategies that address the social determinants of health and that are tailored to the specific needs of AI/ANs and NH/PIs in the U.S.
authors: Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, International Research and Programs Branch, Atlanta, GA, USA. dpu2@cdc.gov
authors: Emily
authors: E
authors: Bloss
authors: Timothy H
authors: TH
authors: Holtz
authors: John
authors: J
authors: Jereb
authors: John T
authors: JT
authors: Redd
authors: Laura Jean
authors: LJ
authors: Podewils
authors: James E
authors: JE
authors: Cheek
authors: Eugene
authors: E
authors: McCray
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000413:Alaska / Q000453:epidemiology / Q000208:ethnology; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006254:Hawaii / Q000453:epidemiology / Q000208:ethnology; D006305:Health Status Indicators; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D004930:Inuit / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data; D011159:Population Surveillance; D012307:Risk Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology / Q000208:ethnology*; D014481:United States / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents