LATEBREAKER
Health Disparities
Risk factors underlying racial/ethnic disparities in tuberculosis diagnosis and treatment outcomes, 2011-2019: a multiple mediation analysis of national surveillance data Mathilda Regan* Mathilda Regan Terrika Barham Yunfei Li Nicole A Swartwood Garrett R Beeler Asay Ted Cohen C Robert Horsburgh, Jr Awal Khan Suzanne M Marks Ranell L· Myles Joshua A Salomon Julie L Self Carla Winston Nicolas A Menzies
There are persistent racial/ethnic disparities in tuberculosis (TB) outcomes in the United States. This study examines the extent to which inequalities in health and socioeconomic status mediate these disparities. We extracted data from the US National TB Surveillance System on TB patients during 2011-2019. We used a sequential multiple mediation approach to evaluate eight potential mediators: three comorbid conditions (HIV, end-stage renal disease [ESRD], diabetes), homelessness, and four census-tract-level measures (poverty, unemployment, insurance coverage, and racialized economic segregation). We estimated the marginal contribution of each mediator using Shapley values. During 2011-2019, 27,788 US-born persons were diagnosed with active TB. Black and Hispanic persons had higher risks of not completing TB treatment during this time period, relative to White persons (aRR 1.27, 95% CI 1.19-1.35; aRR 1.22, 95% CI 1.11-1.33, respectively). In multiple mediator analysis, the eight measured mediators explained 72% of the disparity for Black persons and 69% for Hispanic persons. The biggest contributors to these disparities for both Black and Hispanic persons were concomitant ESRD, concomitant HIV, census-tract-level racialized economic segregation and census-tract-level poverty. Our findings underscore the need for initiatives to reduce disparities in TB outcomes among US-born persons, particularly in highly racially and economically polarized neighborhoods. Mitigating the structural and environmental factors that lead to disparities in the prevalence of comorbidities and their case management should be a priority.