Current Trends, Changing Demographics Barry Dickman, MPA Director - - PDF document

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Current Trends, Changing Demographics Barry Dickman, MPA Director - - PDF document

Mar 19, 2024 362 likes •485 views

TB In Philadelphia: Current Trends, Changing Demographics Barry Dickman, MPA Director Philadelphia TB Control Program M. Christina Dogbey, MPH Philadelphia TB Control Program Epidemiologist Overview Philadelphia TB Program Overview

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TB In Philadelphia: Current Trends, Changing Demographics

Barry Dickman, MPA Director Philadelphia TB Control Program

  • M. Christina Dogbey, MPH

Philadelphia TB Control Program Epidemiologist

  • Philadelphia TB Program Overview
  • Philadelphia TB Epidemiology
  • Disease Burden
  • Risk factors
  • Drug resistance

Overview

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Percentage of TB Program Budget By Source

18% 25% 57%

City State Federal Total funding for FY 2011: $1,524,260

Source: TB Cooperative Agreement, State TB Grant, Philadelphia City Budget

TB Case Management Model

Monthly Physician Compliance Agreement and Legal Process Disease Surveillance Investigator (DSI) Involvement Home/ Clinic Directly Observed Therapy

TB Patient

Visits in clinic Active Social Worker Involvement Enablers for Clinic Visits (e.g. subway tokens) Regular Review of Therapy Regimens by Medical Director

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TB Epidemiology

  • Disease Burden
  • Risk Factors

– Foreign born – Substance Abuse – HIV status – Other

TB Cases in Commonwealth of Pennsylvania: 2007-2011

42% 58% Philadelphia Cases Pennsylvania Cases (excluding Phila)

Total Number of cases for the time period: 1397

  • Average Philadelphia Case Rate:

7.7 cases per 100,000 population

  • Average Pennsylvania Case Rate:

1.3 cases per 100,000 population Source: Pennsylvania National Electronic Disease Surveillance System (PA-NEDSS)

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Philadelphia TB Cases 1947 to Present

500 1000 1500 2000 2500 3000

1947 1950 1953 1956 1959 1962 1965 1968 1971 1974 1977 1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010 Years Cases

Source: PA-NEDSS, Philadelphia TB Control Archives

Philadelphia TB Cases: 2001-2011

147 129 149 162 101 144 120 116 133 98 96

20 40 60 80 100 120 140 160 180 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Calendar Year Number of Cases

Source: PA-NEDSS

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500 1000 1500 2000 2500 3000 3500 4000 4500 Number of Visits 2007 2008 2009 2010 2011 Year

Lawrence J. Flick Memorial Clinic Patient Visits

Source: Philadelphia TB Control Program Source: PA-NEDSS

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Tuberculosis Case Rates 2001-2010: Philadelphia Compared with Other Large Cities

5 10 15 20 25 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year cases per 100,000 population NYC LA CHI HOUS PHNX PHIL Source: PA-NEDSS, CDC DTBE Reported Tuberculosis in the United States 2010

Philadelphia TB Cases by Race and Ethnicity: 2005-2011

10 20 30 40 50 60 70 2005 2006 2007 2008 2009 2010 2011 Count Year Percent of Cases

White Non Hispanic Black, Non Hispanic All races, Hispanic Asian/Pacific Islander

Source: PA-NEDSS

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7 Number of Foreign vs. U.S. Born Cases of TB in Philadelphia

20 40 60 80 100 120 140 1 9 9 7 1 9 9 8 1 9 9 9 2 2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 8 2 9 2 1 2 1 1

Calendar Year Number of Cases

U.S. Born Foreign Born Source: PA-NEDSS

Philadelphia TB Foreign Born Patients Representing World Health Organization Regions 2007-2011

36% 19% 21% 15% 5% 4% Western Pacific African The Americas (not US) S.E. Asia European Eastern Mediterranean

Source: PA-NEDSS

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Culture Positive vs Clinical Cases

20 40 60 80 100 120 140 160 180

2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 8 2 9 2 1 2 1 1 Calendar Year Number of Cases Culture Positive Clinically Confirmed Source: PA-NEDSS

Risk Factors Associated with TB Disease in Philadelphia Cases: 2005-2010

10 20 30 40 50 60

Percent of Cases HIV Positive Status Substance Abuse Born outside

  • f the U.S.

Other* Risk Factor

*homelessness, residence in a long term care facility or being incarcerated at the time of TB diagnosis

Source: PA-NEDSS

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Philadelphia TB Epidemiology: Risk Factors

  • HIV positive serostatus

–11% of Philadelphia TB cases were HIV positive 3, compared with 1.2% of the general Philadelphia population 1 and 8.6%* of all TB cases in the nation (all ages) 4

* Reporting areas missing HIV data include: California, Georgia, Hawaii, Massachusetts, Vermont, Federated States of Micronesia and U.S. Virgin Islands

  • Substance Abuse (injecting drug use, non injecting

drug use and alcohol abuse)

–24% of Philadelphia TB cases were using injecting, non injecting illicit drugs and/or abusing alcohol at time of diagnosis 3 –Nationally, 12.5% of TB cases were using injecting, non injecting illicit drugs and/or abusing alcohol 4

Philadelphia TB Epidemiology: Risk Factors (2)

  • Homelessness

–5% of cases were homeless at the time of diagnosis or had a history of homelessness 3, compared with 1.2% of the Philadelphia population 2 –Nationally, 5.5% of TB cases were or had a history of homelessness 4

  • Residence in Correctional Facilities

–1.7% of Philadelphia TB cases either were a resident in a correctional facility3, or had a history of incarceration compared with 0.5% of the Philadelphia population 2 –The national rate among TB cases is 4.1% 4

  • Residence in Long-term Care Facilities

–3% of Philadelphia TB cases were either residing in or had a history of residence in long term care facilities (i.e. nursing homes, drug treatment facilities)3 compared with 0.5% of the Philadelphia population 2 –The national rate among TB cases is 2.6% 4

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5 10 15 20 25 Percent 2004 2005 2006 2007 2008 2009 2010 2011 Calendar Year

Proportion of Drug Resistance in Positive Culture U.S. and Foreign Born Cases with Drug Sensitivity Testing: 2004-2011

INH Resistance (U.S. Born) INH Resistance (Foreign Born) Multi-drug Resistance (U.S. Born) Multi-drug Resistance (Foreign Born) Rifampin Resistance (U.S Born) Rifampin Resistance (Foreign Born)

Source: PA-NEDSS

Conclusion

  • The demographics of TB in Philadelphia have

changed considerably in the past few years

  • While the number of TB cases has dropped over

the past few years, the proportion of cases that are foreign born continues to rise

  • Drug resistance is emerging as a challenge in

managing TB in Philadelphia

  • We expect both of these trends to continue
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References

1. AIDS Activities Coordinating Office: Philadelphia Department of Public Health. 2010 Epidemiological Annual Report. Retrieved from: http://www.phila.gov/health/pdfs/2010SurveillanceReportFinal.pdf 2. Census.gov. Commonwealth of Pennsylvania and Philadelphia

  • County. Retrieved from:

http://2010.census.gov/2010census/popmap/ipmtext.php?fl=42:42 001:42101 3. The Pennsylvania Version of the National Electronic Disease Surveillance System (PA-NEDSS) 4.

  • CDC. Reported Tuberculosis in the United States 2010. Atlanta, GA:

U.S. Department of Health and Human Services, CDC, October 2011.