tuberculosis impact in boston residents: 2012 · boston public health commission communicable...
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Building a Healthy Boston
Tuberculosis Impact in Boston Residents: 2012
BOSTON PUBLIC HEALTH COMMISSIONInfectious Disease Bureau
Communicable Disease Control Division
Building a Healthy Boston
BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Number of TB Cases: Boston, 1995-2012
93 8779
8977 82 75
67 64 7057 61
4961 57 58
44 41
0
20
40
60
80
100
120
140
160
180
200
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Num
ber o
f cases
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BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Incidence of TB: Boston, 2000-2012
13.912.7
11.4 10.911.9
9.7 10.48.3
10.4 9.7 9.8
7.1 6.6
02468101214161820
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Rate per 100
,000
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BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Incidence of TB by Gender: Boston, 2010-2012
0
2
4
6
8
10
12
2010 2011 2012
Rate per 100
,000
Male Female
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BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Percent of Reported TB Cases by Age Group: Boston, 2010-2012
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
< 25 years 25‐44 years 45‐64 years > 64 years
Percen
t
2010 2011 2012
Results may not equal 100% due to rounding
Building a Healthy Boston
BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Incidence of TB by Age Group:Boston, 2010-2012
0
5
10
15
20
25
30
2010 2011 2012
Rate per 100
,000
< 20 years 20‐29 years 30‐39 years 40‐49 years 50‐59 years 60‐69 years >= 70 years
Building a Healthy Boston
BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Percent of Reported Tuberculosis Cases by Race/Ethnicity: Boston, 2010-2012
0%
10%
20%
30%
40%
50%
60%
2010 2011 2012
Percen
t
White Black Hispanic Asian Other
Results may not equal 100% due to rounding
Building a Healthy Boston
BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Incidence of TB by Race/Ethnicity: Boston, 2010-2012
05101520253035404550
2010 2011 2012
Rate per 100
,000
White Black Hispanic Asian Other
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BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Incidence of TB Among the Homeless:Boston, 2010-2012
0
10
20
30
40
50
60
70
80
90
100
2010 2011 2012
Rate per 100
,000
Building a Healthy Boston
BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
TB Cases by Birthplace: Boston, 2010-2012
0
20
40
60
80
100
2010 2011 2012
Percen
t
US Born Foreign Born
Results may not equal 100% due to rounding
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BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Length of US Residence for Foreign Born TB Cases Prior to TB Diagnosis: Boston, 2010-2012
0
20
40
60
80
100
2010 2011 2012
Percen
t
<1 year 1‐5 years 6‐10 years > 10 years
Results may not equal 100% due to rounding
Building a Healthy Boston
BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Region of Birth for TB Cases: Boston, 2012
0 5 10 15 20 25 30
Africa
Asia
Carribean
Central/South America
Europe
North America
Percent
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BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Primary Site of TB Disease: Boston, 2012
64%
12%
7%17%
Pulmonary
Lymphatic
Pleural
Other
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BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Sputum Smear and Culture Results for Cases with Primary Pulmonary TB: Boston, 2010-2012
0
5
10
15
20
2010* 2011** 2012***
Num
ber o
f cases
Smear+/Culture+ Smear+/Culture‐ Smear‐/Culture+ Smear‐/Culture‐
*Sputum samples unavailable for 2 cases**Sputum samples unavailable for 3 cases***Sputum samples unavailable for 1 case
Building a Healthy Boston
BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Drug Resistance in TB Cases:Boston, 2012
Number
One Drug Streptomycin 1
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BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Completeness of HIV Testing* of TB Cases: Boston, 2010-2012
0102030405060708090
100
2010 2011 2012
Percen
t
*Includes cases with negative, positive and indeterminate HIV test results
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BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Percent TB Cases with HIV Infection:* Boston, 2010-2012
0
2
4
6
8
10
2010 2011 2012
Percen
t
*Of those tested
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BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
What health care sites are diagnosing and initiating TB treatment for Boston cases?
2011**N=42
2012*N=40
Diagnosing site Inpatient 29(66%) 31(77%)
Outpatient 15(34%) 9(22%)
Initial treatment site*
Inpatient 28(67%) 31(77%)
TB clinic 10(24%) 7(17%)
Hospital outpatient clinic
2(5%) 2(5%)
Other 2(5%) 0(0%)
*1 case died prior to identification of tuberculosis**2 case died prior to identification of tuberculosis Results may not equal 100% due to rounding
Building a Healthy Boston
BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Who do Boston TB cases identify as their primary care site?
2011N=44
2012N=41
Hospital outpatient clinic 17 (39%) 17 (41%)
Community health center 13 (30%) 16 (39%)
Private practices 1 (2%) 1 (2%)
Other sites 6 (14%) 1 (2%)
None identified 7 (16%) 6 (15%)
Results may not equal 100% due to rounding
Building a Healthy Boston
BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Boston Residents with Latent TB Infection (N=1,446) Evaluated at the BPHC TB Clinic, Incidence by Gender: 2012
0 25 50 75 100 125 150 175 200 225 250 275
Male
Female
Rate per 100,000
Building a Healthy Boston
BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Boston Residents with Latent TB Infection (N=1,446) Evaluated at the BPHC TB Clinic, Incidence by Age Group: 2012
0.0
50.0
100.0
150.0
200.0
250.0
300.0
350.0
400.0
Rate per 100
,000
<10 Years 10‐19 years 20‐29 years 30‐39 years
40‐49 years 50‐59 years 60‐69 years >= 70 years
Building a Healthy Boston
BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Percent of Boston Residents with Latent TB Infection (N=1,446) Evaluated at the BPHC TB Clinic by Race/Ethnicity: 2012
26%
39%
19%
9%3% 4%
AsianBlackHispanicOtherUnknownWhite
Building a Healthy Boston
BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
Boston Residents with Latent TB Infection (N=1,446) Evaluated at the BPHC TB Clinic, Incidence by Neighborhood: 2012
0
100
200
300
400
500
600
Rate per 100,000
Building a Healthy Boston
BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION
For More Information:
BOSTON PUBLIC HEALTH COMMISSIONCommunicable Disease Control Division
1010 Massachusetts AvenueBoston, MA 02118
Phone: 617‐534‐5611Fax: 617‐534‐5905
Website: www.bphc.org