Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014: a population-based study
Background: Tuberculosis continues to disproportionately affect many Indigenous populations in the USA, Canada, and Greenland. We aimed to investigate whether population-based tuberculosis-specific interventions or changes in general health and socioeconomic indicators, or a combination of these fac...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-03-01
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| Series: | The Lancet Public Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468266718300021 |
| _version_ | 1818199393442988032 |
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| author | Kianoush Dehghani, MD Zhiyi Lan, MSc Peizhi Li, MSc Sascha Wilk Michelsen, PhD Sean Waites, BA Andrea Benedetti, PhD Pierre Lejeune, BPs Jill Torrie, MA Elizabeth Robinson, MD Berenica Vejvoda, MISt Muhammad Mullah, PhD Diana Redwood, PhD Michael Cooper, MD Anne Fanning, FRCPC Wadieh Yacoub, MD Gonzalo G Alvarez, MD Bolette Søborg, PhD Richard Long, MD Dick Menzies, MD |
| author_facet | Kianoush Dehghani, MD Zhiyi Lan, MSc Peizhi Li, MSc Sascha Wilk Michelsen, PhD Sean Waites, BA Andrea Benedetti, PhD Pierre Lejeune, BPs Jill Torrie, MA Elizabeth Robinson, MD Berenica Vejvoda, MISt Muhammad Mullah, PhD Diana Redwood, PhD Michael Cooper, MD Anne Fanning, FRCPC Wadieh Yacoub, MD Gonzalo G Alvarez, MD Bolette Søborg, PhD Richard Long, MD Dick Menzies, MD |
| author_sort | Kianoush Dehghani, MD |
| collection | DOAJ |
| description | Background: Tuberculosis continues to disproportionately affect many Indigenous populations in the USA, Canada, and Greenland. We aimed to investigate whether population-based tuberculosis-specific interventions or changes in general health and socioeconomic indicators, or a combination of these factors, were associated with changes in tuberculosis incidence in these Indigenous populations.
Methods: For this population-based study we examined annual tuberculosis notification rates between 1960 and 2014 in six Indigenous populations of the USA, Canada, and Greenland (Inuit [Greenland], American Indian and Alaska Native [Alaska, USA], First Nations [Alberta, Canada], Cree of Eeyou Istchee [Quebec, Canada], Inuit of Nunavik [Quebec, Canada], and Inuit of Nunavut [Canada]), as well as the general population of Canada. We used mixed-model linear regression to estimate the association of these rates with population-wide interventions of bacillus Calmette-Guérin (BCG) vaccination of infants, radiographic screening, or testing and treatment for latent tuberculosis infection (LTBI), and with other health and socioeconomic indicators including life expectancy, infant mortality, diabetes, obesity, smoking, alcohol use, crowded housing, employment, education, and health expenditures.
Findings: Tuberculosis notification rates declined rapidly in all six Indigenous populations between 1960 and 1980, with continued decline in Indigenous populations in Alberta, Alaska, and Eeyou Istchee thereafter but recrudescence in Inuit populations of Nunavut, Nunavik, and Greenland. Annual percentage reductions in tuberculosis incidence were significantly associated with two tuberculosis control interventions, relative to no intervention, and after adjustment for infant mortality and smoking: BCG vaccination (–11%, 95% CI −6 to −17) and LTBI screening and treatment (–10%, −3 to −18). Adjusted associations were not significant for chest radiographic screening (–1%, 95% CI −7 to 5). Declining tuberculosis notification rates were significantly associated with increased life expectancy (–37·8 [95% CI −41·7 to −33·9] fewer cases per 100 000 for each 1-year increase) and decreased infant mortality (–9·0 [–9·5 to −8·6] fewer cases per 100 000 for each death averted per 1000 livebirths) in all six Indigenous populations, but no significant associations were observed for other health and socioeconomic indicators examined.
Interpretation: Population-based BCG vaccination of infants and LTBI screening and treatment were associated with significant decreases in tuberculosis notification rates in these Indigenous populations. These interventions should be reinforced in populations still affected by tuberculosis, while also addressing the persistent health and socioeconomic disparities.
Funding: Public Health Department of the Cree Board of Health and Social Services of James Bay. |
| first_indexed | 2024-12-12T02:21:03Z |
| format | Article |
| id | doaj.art-081c0f79784c406796b34bc54bf98225 |
| institution | Directory Open Access Journal |
| issn | 2468-2667 |
| language | English |
| last_indexed | 2024-12-12T02:21:03Z |
| publishDate | 2018-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Public Health |
| spelling | doaj.art-081c0f79784c406796b34bc54bf982252022-12-22T00:41:41ZengElsevierThe Lancet Public Health2468-26672018-03-0133e133e14210.1016/S2468-2667(18)30002-1Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014: a population-based studyKianoush Dehghani, MD0Zhiyi Lan, MSc1Peizhi Li, MSc2Sascha Wilk Michelsen, PhD3Sean Waites, BA4Andrea Benedetti, PhD5Pierre Lejeune, BPs6Jill Torrie, MA7Elizabeth Robinson, MD8Berenica Vejvoda, MISt9Muhammad Mullah, PhD10Diana Redwood, PhD11Michael Cooper, MD12Anne Fanning, FRCPC13Wadieh Yacoub, MD14Gonzalo G Alvarez, MD15Bolette Søborg, PhD16Richard Long, MD17Dick Menzies, MD18Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, CanadaDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, CanadaRespiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, QC, CanadaDepartment of Epidemiology Research, Statens Serum Institut, Copenhagen, DenmarkDepartment of Health, Government of Nunavut, Iqaluit, NU, CanadaDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, CanadaPublic Health Department of the Cree Board of Health and Social Services of James Bay, Montreal, QC, CanadaPublic Health Department of the Cree Board of Health and Social Services of James Bay, Montreal, QC, CanadaPublic Health Department of the Cree Board of Health and Social Services of James Bay, Montreal, QC, CanadaMcGill Libraries, McGill University, Montreal, QC, CanadaDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, CanadaAlaska Native Tribal Health Consortium, Anchorage, AK, USAFamily Medicine, Anchorage, AK, USADepartment of Medicine, University of Alberta Edmonton, AB, CanadaFirst Nations and Inuit Health Branch, Health Canada, Alberta Region, Edmonton, AB, CanadaSchool of Epidemiology and Public Health, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, CanadaDepartment of Epidemiology Research, Statens Serum Institut, Copenhagen, DenmarkDepartment of Medicine, University of Alberta Edmonton, AB, CanadaDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, CanadaBackground: Tuberculosis continues to disproportionately affect many Indigenous populations in the USA, Canada, and Greenland. We aimed to investigate whether population-based tuberculosis-specific interventions or changes in general health and socioeconomic indicators, or a combination of these factors, were associated with changes in tuberculosis incidence in these Indigenous populations. Methods: For this population-based study we examined annual tuberculosis notification rates between 1960 and 2014 in six Indigenous populations of the USA, Canada, and Greenland (Inuit [Greenland], American Indian and Alaska Native [Alaska, USA], First Nations [Alberta, Canada], Cree of Eeyou Istchee [Quebec, Canada], Inuit of Nunavik [Quebec, Canada], and Inuit of Nunavut [Canada]), as well as the general population of Canada. We used mixed-model linear regression to estimate the association of these rates with population-wide interventions of bacillus Calmette-Guérin (BCG) vaccination of infants, radiographic screening, or testing and treatment for latent tuberculosis infection (LTBI), and with other health and socioeconomic indicators including life expectancy, infant mortality, diabetes, obesity, smoking, alcohol use, crowded housing, employment, education, and health expenditures. Findings: Tuberculosis notification rates declined rapidly in all six Indigenous populations between 1960 and 1980, with continued decline in Indigenous populations in Alberta, Alaska, and Eeyou Istchee thereafter but recrudescence in Inuit populations of Nunavut, Nunavik, and Greenland. Annual percentage reductions in tuberculosis incidence were significantly associated with two tuberculosis control interventions, relative to no intervention, and after adjustment for infant mortality and smoking: BCG vaccination (–11%, 95% CI −6 to −17) and LTBI screening and treatment (–10%, −3 to −18). Adjusted associations were not significant for chest radiographic screening (–1%, 95% CI −7 to 5). Declining tuberculosis notification rates were significantly associated with increased life expectancy (–37·8 [95% CI −41·7 to −33·9] fewer cases per 100 000 for each 1-year increase) and decreased infant mortality (–9·0 [–9·5 to −8·6] fewer cases per 100 000 for each death averted per 1000 livebirths) in all six Indigenous populations, but no significant associations were observed for other health and socioeconomic indicators examined. Interpretation: Population-based BCG vaccination of infants and LTBI screening and treatment were associated with significant decreases in tuberculosis notification rates in these Indigenous populations. These interventions should be reinforced in populations still affected by tuberculosis, while also addressing the persistent health and socioeconomic disparities. Funding: Public Health Department of the Cree Board of Health and Social Services of James Bay.http://www.sciencedirect.com/science/article/pii/S2468266718300021 |
| spellingShingle | Kianoush Dehghani, MD Zhiyi Lan, MSc Peizhi Li, MSc Sascha Wilk Michelsen, PhD Sean Waites, BA Andrea Benedetti, PhD Pierre Lejeune, BPs Jill Torrie, MA Elizabeth Robinson, MD Berenica Vejvoda, MISt Muhammad Mullah, PhD Diana Redwood, PhD Michael Cooper, MD Anne Fanning, FRCPC Wadieh Yacoub, MD Gonzalo G Alvarez, MD Bolette Søborg, PhD Richard Long, MD Dick Menzies, MD Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014: a population-based study The Lancet Public Health |
| title | Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014: a population-based study |
| title_full | Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014: a population-based study |
| title_fullStr | Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014: a population-based study |
| title_full_unstemmed | Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014: a population-based study |
| title_short | Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014: a population-based study |
| title_sort | determinants of tuberculosis trends in six indigenous populations of the usa canada and greenland from 1960 to 2014 a population based study |
| url | http://www.sciencedirect.com/science/article/pii/S2468266718300021 |
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