Area-Based Sociodemographic Factors Associated with Latent Tuberculosis Infection in a Low-Prevalence Setting

Jeffrey I. Campbell Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts;
Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts;

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Mary Tabatneck Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;

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Grete E. Wilt Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts;

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Mingwei Sun Center for Research Information Technology, Boston Children’s Hospital, Boston, Massachusetts;

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Wei He Center for Research Information Science and Computing, Massachusetts General Hospital, Boston, Massachusetts;

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Nicholas Musinguzi Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda;

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Bethany Hedt-Gauthier Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;

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Gabriella S. Lamb Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;

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Don Goldmann Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;

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Vishakha Sabharwal Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts;
Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts;

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Thomas J. Sandora Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;

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Jessica E. Haberer Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts

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ABSTRACT.

Area-based sociodemographic markers, such as census tract foreign-born population, have been used to identify individuals and communities with a high risk for tuberculosis (TB) infection in the United States. However, these markers have not been evaluated as independent risk factors for TB infection in children. We evaluated associations between census tract poverty, crowding, foreign-born population, and the CDC’s Social Vulnerability Index (CDC-SVI) ranking and TB infection in a population of children tested for TB infection in Boston, Massachusetts. After adjustment for age, crowding, and foreign-born percentage, increasing census tract poverty was associated with increased odds of TB infection (adjusted odds ratio [aOR] per 10% increase in population proportion living in poverty: 1.20 [95% CI, 1.04–1.40]; P = 0.01), although this association was attenuated after further adjustment for preferred language. In separate models, increasing CDC-SVI ranking was associated with increased odds of TB infection, including after adjustment for age and language preference (aOR per 10-point increase in CDC-SVI rank: 1.08 [95% CI, 1.02–1.15]; P = 0.01). Our findings suggest area-based sociodemographic factors may be valuable for characterizing TB infection risk and defining the social ecology of pediatric TB infection in low-burden settings.

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Author Notes

Address correspondence to Jeffrey I. Campbell, Section of Pediatric Infectious Diseases, Boston Medical Center, 670 Albany St., 6th Fl., Boston, MA 02115-5724. E-mail: jeffrey.campbell@bmc.org

Funding support: J. I. C. was supported by Agency for Healthcare Research and Quality grant number T32 HS000063 as part of the Harvard-wide Pediatric Health Services Research Fellowship Program. J. E. H. was supported by K24MH114732.

Authors’ addresses: Jeffrey I. Campbell and Vishakha Sabharwal, Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, MA, and Boston University Chobanian & Avedisian School of Medicine, Boston, MA. E-mails: jeffrey.campbell@bmc.org and Vishakha.Sabharwal@bmc.org. Mary Tabatneck, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, E-mail: Mary.Tabatneck@childrens.harvard.edu. Grete E. Wilt, Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, E-mail: gwilt@fas.harvard.edu. Mingwei Sun, Center for Research Information Technology, Boston Children’s Hospital, Boston, MA, E-mail: sunmingwei09@gmail.com. Wei He, Center for Research Information Science and Computing, Massachusetts General Hospital, Boston, MA, E-mail: WHE3@mgh.harvard.edu. Nicholas Musinguzi, Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda, E-mail: nmusinguzi@gmail.com. Bethany Hedt-Gauthier, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, E-mail: bethhedt@gmail.com. Gabriella S. Lamb, Don Goldmann, and Thomas J. Sandora, Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, E-mails: gabriella.sophia.lamb@gmail.com, Don.Goldmann@childrens.harvard.edu, and Thomas.Sandora@childrens.harvard.edu. Jessica E. Haberer, Center for Global Health, Massachusetts General Hospital, Boston, MA, E-mail: jhaberer@partners.org.

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