title: The road to tuberculosis (Mycobacterium tuberculosis) elimination in Arkansas; a re-examination of risk groups.
abstract: OBJECTIVE
  This study was conducted to generate knowledge useful for developing public health interventions for more effective tuberculosis control in Arkansas.
  
  
  METHODS
  The study population included 429 culture-confirmed reported cases (January 1, 2004-December 31, 2010). Mycobacterium tuberculosis genotyping data were used to identify cases likely due to recent transmission (clustered) versus reactivation (non-clustered). Poisson regression models estimated average decline rate in incidence over time and assessed the significance of differences between subpopulations. A multinomial logistic model examined differences between clustered and non-clustered incidence.
  
  
  RESULTS
  A significant average annual percent decline was found for the overall incidence of culture-confirmed (9%; 95% CI: 5.5%, 16.9%), clustered (6%; 95% CI: 0.5%, 11.6%), and non-clustered tuberculosis cases (12%; 95% CI: 7.6%, 15.9%). However, declines varied among demographic groups. Significant declines in clustered incidence were only observed in males, non-Hispanic blacks, 65 years and older, and the rural population.
  
  
  CONCLUSIONS
  These findings suggest that the Arkansas tuberculosis control program must target both traditional and non-traditional risk groups for successful tuberculosis elimination. The present study also demonstrates that a thorough analysis of TB trends in different population subgroups of a given geographic region or state can lead to the identification of non-traditional risk factors for TB transmission. Similar studies in other low incidence populations would provide beneficial data for how to control and eventually eliminate TB in the U.S.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Anna
authors.initials: A
authors.lastname: Berzkalns
authors.affiliation: Arkansas Department of Health, Little Rock, Arkansas, United States of America; Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bates
authors.affiliation: Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Wen
authors.initials: W
authors.lastname: Ye
authors.affiliation: Arkansas Department of Health, Little Rock, Arkansas, United States of America; Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America.
authors.forename: Leonard
authors.initials: L
authors.lastname: Mukasa
authors.affiliation: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: France
authors.affiliation: Arkansas Department of Health, Little Rock, Arkansas, United States of America; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America.
authors.forename: Naveen
authors.initials: N
authors.lastname: Patil
authors.affiliation: Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Zhenhua
authors.initials: Z
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001131:Arkansas / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D005838:Genotype; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics; D062486:Public Health Surveillance; D012307:Risk Factors; D012424:Rural Population; D012737:Sex Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control*; D014505:Urban Population; D055815:Young Adult