Abstract
BackgroundRace and place intersect to produce location-based variation in disease distributions. We analyzed the geographic distribution of tuberculosis (TB) incidence in Michigan, USA to better understand the complex interplay between race and place, comparing patterns in Detroit, Wayne County and the state of Michigan as a whole.MethodsUsing cross-sectional TB surveillance data from the Michigan Department of Health and Human Services, multivariable statistical models were developed to analyze the residence patterns of TB incidence from 2007 through 2012. Two-way interactions among the residence location and race of cases were assessed.ResultsOverall, Detroit residents experienced 58% greater TB incidence than residents of Wayne County or the state of Michigan. Racial inequalities were less pronounced in Detroit compared to both Wayne County and the state of Michigan. Blacks in Detroit had 2.01 times greater TB incidence than Whites, while this inequality was 3.62 times more in Wayne County and 8.72 greater in the state of Michigan.ConclusionOur results highlight how race and place interact to influence patterns of TB disease, and the ways in which this interaction is context dependent. TB elimination in the U.S. will require strategies that address the local social environment, as much as the physical environment.
Highlights
Race and place intersect to produce location-based variation in disease distributions
Racial inequalities in both chronic and infectious diseases have been well-documented in the U.S For example, in 2007 the mortality rate of Blacks was ~ 30% higher compared to Whites for 10 of the 15 leading causes of death [1]
We found that the inequalities for race/ethnicity were substantially smaller in Detroit compared to Wayne County and the rest of the state of Michigan (Table 3)
Summary
Race and place intersect to produce location-based variation in disease distributions. We analyzed the geographic distribution of tuberculosis (TB) incidence in Michigan, USA to better understand the complex interplay between race and place, comparing patterns in Detroit, Wayne County and the state of Michigan as a whole. Racial inequalities in both chronic and infectious diseases have been well-documented in the U.S For example, in 2007 the mortality rate of Blacks was ~ 30% higher compared to Whites for 10 of the 15 leading causes of death [1]. This results in people of minority races often experiencing persistent disadvantage
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