美洲印第安人和阿拉斯加原住民 (AIAN) 人群的结核病 (TB) 发病率在美国所有种族/族裔群体中通常最高。我们系统地研究了地理上不同的 AIAN 亚组之间结核病流行病学模式和潜在驱动因素的差异。

使用 2010 年至 2020 年期间向国家结核病监测系统报告的数据，我们应用数据分解的地理方法来比较阿拉斯加 AIAN 人群与其他州 AIAN 人群的年度结核病发病率和结核病患者特征的频率。我们使用美国人口普查数据来比较这两个地理区域的 AIAN 社区住房条件不合格的普遍程度。

阿拉斯加 AIAN 人群的年平均结核病发病率比其他州的 AIAN 人群高 21 倍。与其他州的 AIAN 结核病患者相比，阿拉斯加的 AIAN 结核病患者与多种流行病学结核病危险因素（例如，结核病归因于近期传播、既往结核病诊断）的频率显着较高相关，而多种临床结核病的发生频率则显着较低。结核病的危险因素（例如，诊断为糖尿病、终末期肾病）。与其他州的 AIAN 社区相比，阿拉斯加州 AIAN 社区的有人居住的住房单元与多种不合格住房条件指标的发生频率显着较高。

观察到的患者特征和不合格住房条件的差异与地理上不同的 AIAN 亚组中结核病流行病学的对比综合征一致，并提出了可以调整相关公共卫生干预措施以提高疗效的方法。

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Background

American Indian and Alaska Native (AIAN) populations are frequently associated with the highest rates of tuberculosis (TB) disease of any racial/ethnic group in the USA. We systematically investigated variation in patterns and potential drivers of TB epidemiology among geographically distinct AIAN subgroups.

Using data reported to the National Tuberculosis Surveillance System during 2010–2020, we applied a geographic method of data disaggregation to compare annual TB incidence and the frequency of TB patient characteristics among AIAN persons in Alaska with AIAN persons in other states. We used US Census data to compare the prevalence of substandard housing conditions in AIAN communities in these two geographic areas.

The average annual age-adjusted TB incidence among AIAN persons in Alaska was 21 times higher than among AIAN persons in other states. Compared to AIAN TB patients in other states, AIAN TB patients in Alaska were associated with significantly higher frequencies of multiple epidemiologic TB risk factors (e.g., attribution of TB disease to recent transmission, previous diagnosis of TB disease) and significantly lower frequencies of multiple clinical risk factors for TB disease (e.g., diagnosis with diabetes mellitus, end-stage renal disease). Occupied housing units in AIAN communities in Alaska were associated with significantly higher frequencies of multiple measures of substandard housing conditions compared to AIAN communities in other states.

Observed differences in patient characteristics and substandard housing conditions are consistent with contrasting syndromes of TB epidemiology in geographically distinct AIAN subgroups and suggest ways that associated public health interventions could be tailored to improve efficacy.